OASIS Alert

Try once more - in writing.

Question: We admitted a patient to home care and transferred him to the hospital (not discharged from agency) before he could be seen again. We received resumption of care orders from the doctor, but we can't get in touch with the patient. He is not homebound and won't even return our phone calls. Because he is in the middle of an episode, do we just go ahead and discharge him or keep him on hold for the remainder of his certification period?

Answer: In this situation, holding is probably not the best course, says clinical consultant Judy Adams with Charlotte, NC-based LarsonAllen Health Care Group. If the patient is not homebound, he would not qualify for the Medicare benefit and he does not appear to be interested in home care, she counsels.

You might want to send a letter to the patient, Adams recommends. Explain that you have received a referral but because you have been unable to contact him you will discharge him as not needing home care, unless you hear from him or his representative within 10 days from the date of the letter. This approach gives him one more opportunity to respond and "closes the loop," she says.

If you still don't hear from the patient, discharge him and notify the physician about the circumstances, she adds.

Tip: Remember, because you originally planned more than one skilled nursing visit, but hospitalization prevented you from completing them, you can bill for the assessment visit - but it will be a low utilization payment adjustment (LUPA).