Documenting Medical Necessity: A Practical Guide for Home Health

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Documenting Medical Necessity: A Practical Guide for Home Health

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Documenting Medical Necessity: A Practical Guide for Home Health

Heather Calhoun, RN, BSN, HCS-D, COS-C 

Initial patient assessment in home health can be tricky. If documentation does not adequately provide a reason for skilled nursing care in the home, you might not get reimbursed at all. In Documenting Medical Necessity: A Practical Guide for Home Health, author Heather Calhoun, RN, BSN, HCS-D, COS-C, provides down-to-earth, conversational documentation tips with dozens of example scenarios to help nurses understand medical necessity and document in a manner that encourages proper and complete reimbursement.

In addition to initial assessments for skilled services, continued skilled care must also be properly documented. This resource will help nurses provide skilled services based on critical thinking throughout the continuum of care.

This book has:

  • A grounded, conversational style that speaks directly to nurses who are responsible for the documentation
  • Dozens of hypothetical examples that provide concrete learning opportunities
  • Scenarios that are available electronically to provide handouts for ongoing and on-the-go learning
  • Content that serves as a great resource for orientation and annual training


Table of Contents

  • Background of Medical Necessity
    • Criteria Changes of 1997
    • Present-Day Payment Criteria
  • Fundamentals of Medical Necessity
    • Focus of Care
      • Mistakes that lead to rehospitalization
    • Delivery of Care
      • Start of care narrative
    • Frequency of Care
    • Mutually Agreed-Upon Goals
    • Documentation: Paint the Picture
    • Observation and Assessment
    • Teaching and Training
    • Direct Skilled Care
    • Management and Evaluation
    • Psychiatric Nursing
  • Therapy
    • Initial Assessment
    • Standardized Tools
    • 30-Day Reevaluation
    • Therapy Indications
      • Gait training
      • Range of motion
      • Use of modalities
      • Wound care
      • Occupational therapy
      • Speech therapy
      • Maintenance therapy


About the Author

Heather Calhoun, RN, BSN, HCS-D, COS-C, is the education director for Home Health Solutions, LLC, and has been in the homecare industry for the past 20 years. She received her BS in nursing from the University of Alabama in Birmingham in 1992. She has extensive field and case management experience in both home health and hospice. Calhoun has held various positions in home health and hospice agencies such as performance improvement coordinator, staff development director, and appeals auditor. She has extensive knowledge of state and federal regulatory guidelines.


Published: August 2015

Page count: 110
Dimensions: 8.5x11
ISBN: 978-1-55645-721-0