Have you ever said those words or heard them in your home care agency? All too often we are in agencies that react that way when the surveyors show up on the doorstep for the annual or semiannual survey. Panic sets in and everyone is on edge. Why? It’s usually because the homecare management is not sure everything is in order as it should be, and they are afraid they will be cited for deficiencies. Minimize the “home care surveyor stress” with methodical systems that are maintained with a religious fervor.
Internal systems set up for compliance include:
- chart audits for completion of all required documents; e.g, initial assessment, care plan, signed orders and interim orders if clinical, visit notes that match the scheduled visits, and frequencies that match plan (again if Medicare Home Health).
- pre-billing audits to assure all required documents are in the file before the bills are submitted.
- personnel file audits to assure that all required documents are in the file including updated licenses, auto insurance, etc.
Clinical chart audits include:
- integrity of assessment to diagnosis and coding (if you are a Medicare Agency) and maintaining of the care plan with changes as appropriate.
- required supervisory visits.
- required reassessments especially for therapy (Medicare only agencies).
One of the most frequently cited items in a survey is the lack of congruency between the orders for the home care plans and what the home care aides report they are/are not doing. A home care aide plan of care needs to be followed exactly as written. If a client/patient does not wish a bath on the day it is scheduled, the aide should note that the client/patient declined, and not leave it blank.
The second most frequently cited area of the home care survey is the lack of updates to the plan of care for both the aide and any clinical services being delivered. Even if there are no changes, there must be evidence that the supervising staff member has reviewed the plan and signed and dated to that effect. Additionally, the medication profile requires maintenance. Even if you are only providing medication reminders to the client/patient, the profile must show evidence that it has been updated and is being maintained.
Staff education is another area worthy of attention and an audit system. For Medicare agencies, the required 12 hours a year of aide continuing education must be documented for each home care aide. For states that have mandated continuing education for aides in private duty agencies, there must be evidence that the aides have received the education. Some states require specific types of continuing education. Know your state laws and confirm you are keeping up with the requirements, and that your aides are attending the sessions as required and that the content matches the state requirements.
With strong internal systems in place and field supervisors effectively managing the external services mandated by the rules of the state and/or federal government, your home care survey issues will be minimized. Should you feel you need assistance with establishing any of the audit systems, call Kenyon HomeCare Consulting at 206-721-5091 or e-mail to email@example.com. We are here to help.