HITT 1345-2001 Health Care Delivery System pp 458-460

485

the document number for a previously required CMS form facilitating a patient's orders for home care. Although the requirement for the form itself has been dropped, the content of the form is still required. Therefore, both the term 485 and the form itself are still in use in many home health agencies. the form provides a plan of care, which must be established and reviewed at least once every 60 days by the patient's attending physician

Accreditation Commission for Health Care (ACHC)

a voluntary accrediting organization with deeming authority for home health, hospice, and suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)

affiliate

an associate or member of a particular business

audit

a formal way of checking financial and other records

care plan

an outline for patient care based on a comprehensive assessment and the patient's specific needs that includes goals, objectives, and those responsible for completing the plan

Centers for Medicare & Medicaid Services (CMS)

a federal agency within the Department of Health and Human Services. Its main focus is to administer the Medicare and Medicaid programs. Formerly known as the Health Care Financing Administration

certification period

the billing period for which a physician's home care order is valid for patient treatment -60 days-a time frame in which a patient's physician must review, update, and re-certify (if necessary) a patient's plan of care

Community Health Accreditation Program (CHAP)

an independent, not-for-profit, accrediting body for community-based health care organizations. Meeting CHAP standards can provide a home health agency with deemed status with regard to the Medicare Conditions of Participation

comprehensive assessment

a document that is completed on the first visit to the patient's home. The document should include the patient's present illness; significant past history; review of all systems/physical assessment; medications; psychological, social, and economic factors; emergency plans; and skilled nursing performed that day, as well as incorporate the required OASIS data elements

Conditions of Participation

federal regulations with which home health agencies must comply in order to participate in the Medicare program. In addition to other regulations, the COP outline documentation requirements for Medicare-certified home health agencies

deemed status

a status conferred by the Centers for Medicare & Medicaid Services (CMS) to health care providers who meet the voluntary standards of an accrediting organization whose standards have been determined by CMS to be the equivalent of the Medicare Conditions of Participation in that particular category. An organization with deemed status is no longer subject to routine surveys under the Medicare Conditions of Participation

denial

lack of payment for home visits/treatments due to failure to meet medical necessity requirement for the services or for some other reason. Can sometimes be appealed successfully

disciplines

specialty providers offering a variety of treatments or services for patients, for example, physical therapy, maternity service, medical social services, and so on

durable medical equipment (DME)

medical equipment provided to the patient within the home environment

fixed costs

costs that do not change in proportion to changes in volume of services. Office rent and utilities are examples of fixed costs in home health

Home Assessment Validation and Entry (HAVEN)

software available from CMS, developed to provide home health agencies with an electronic application for data entry, editing, and validation of OASIS-C data

homebound

when an individual is physically or mentally limited and is able to leave his or her home only infrequently and with great effort, generally requiring assistance

home care visit

medical and nonmedical treatments provided to patients within the privacy and comfort of their own homes. Is often used as the unit of measure in home health care for evaluating costs, scheduling, and productivity. For some payers, the visit is the unit of payment for services

home health aide

a certified staff person who is able to enhance the patient's care by assisting with the patient's activities of daily living, such as checking vital signs, bathing, grooming, meal preparation, and so on

home health care

service and treatment provided in the home environment to a recovering, disabled, or chronically ill person to improve health or effective functioning

incident/unusual occurrence

any happening that is not consistent with the routine operations of the agency or routine care of a particular patient

integrated format

a record in which the information is organized in a strict chronological order

The Joint Commission (TJC)

promotes quality in home care by accrediting a variety of organizations that provide home care services. Meeting these standards provides a home health agency with deemed status with regard to the Medicare Conditions of Participation

National Association for Home Care and Hospice (NAHC)

an association for organizations and individuals who provide health care and supportive services on an outreach basis to patients in their homes

non-physician practitioner (NPP)

in the context of certifying the necessity of home care services, an NPP is "a nurse practitioner or clinical nurse specialist..., who is working in collaboration with the physician in accordance with State law, or a certified nurse-midwife..., or a physician assistant..., under the supervision of the physician

Occupational Safety and Health Administration (OSHA)

a federal agency that develops criteria meant to provide a safe work environment for all employees as part of its mission to enforce occupational safety and health legislation

outcome

end result or consequence; the patient's health and functional status after a period of treatment

Outcome and Assessment Information Set-C (OASIS-C)

a data set requirement under Medicare's Conditions of Participation. Medicare-certified home health agencies collect and use OASIS data when evaluating adult, nonmaternity patients. the intent of OASIS is to make the Conditions of Participation more patient-centered and outcome-oriented while providing home care agencies with more flexibility to operate their programs. It also measures treatment outcomes and provides individual agencies with the ability to compare themselves to the national data set

payer mix

a ratio of an agency's various patient insurers and third party payers

problem-oriented record

a record organized by the patient's problems; follow each clinical problem individually and provides a systematic method of documentation to reflect logical thinking on the part of the one directing the care of the patient

recertification

additional physician orders continuing home health services after the initial 60-day certification period

skilled nursing agencies

agencies that offer nursing services such as trained medical-surgical nursing, intravenous therapy, enterostomal therapy, psychiatric or mental health, maternity, or restorative nursing. Services are provided to patients based on their individual needs

source-oriented record

a record organized in sections according to patient care departments and/or disciplines

standards

rules used as a basis of comparison for measuring quantitative or qualitative value

variable costs

costs that vary in proportion to the volume of service provided