Chapter 38 – What is SN in Home Health Skilled Nursing?

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SN is short for skilled nursing. An SN can either be an RN or LVN. RN visits patients for observation, assessment, and evaluation. Home health nurses also keep journals of each patient’s condition. These visits are non-reimbursable. RN visits are required for COVID-19 monitoring and may be provided in the patient’s home for the duration of the illness. Home health nurses are often not reimbursed, so they must seek reimbursement from insurance companies.

RN visits for skilled nursing observation, assessment, and evaluation

An RN must make at least one on-site visit per 60-day episode to supervise home health aides who are performing skilled services. In addition to onsite visits, an RN can also make virtual supervisory visits. This is possible through two-way audio-video telecommunications technology. However, the RN must be a skilled professional. For this reason, an aide cannot exceed one virtual supervision visit per patient per 60-day episode.

A licensed RN must make an initial assessment visit to determine if the patient needs immediate care. The nurse must also determine if the patient meets Medicare requirements for a home health benefit and is homebound. If this is the case, the RN must make the home visit within 48 hours of the referral or return home date. It is also necessary to note that a skilled nursing visit is not a substitute for a doctor’s care.

Using a 10th percentile value of total visits, the federal government has established payment thresholds for RN visits for skilled nursing observation, assessment and evaluation. For case-mix groups, the threshold is two visits per year. A RN should make at least one of these visits per client per day. A skilled nursing visit can prevent admission to a hospital or a nursing facility.

Moreover, RN visits for skilled nursing observation, assessment and evaluation in home health are mandatory if the patient has a prior diagnosis of a medical condition. If the diagnosis is not correct, the patient will have to undergo another assessment visit. During the assessment visit, the nurse must also observe the patient’s daily activities. During the observation visit, the nurse should also make sure the home health aides are able to perform their duties properly.

RN visits for skilled nursing observation, assessment and evaluation in home health may also include medication administration. An RN may administer intravenous medications or administer an infusion. The purpose of these visits is to administer medications. If a licensed nurse is necessary for the administration of these medications, a visit for medication administration will be considered a skilled nursing observation. For other medication administration tasks, a skilled nurse may be required to perform a full assessment of the patient’s medical condition.

Intermittent skilled nursing visits involve direct, skilled nursing services. Such visits are generally shorter than two consecutive hours, and are based on the Member’s individual needs. A Licensed Registered Nurse or a Licensed Practical Nurse may perform these tasks safely. RN visits for skilled nursing observation, assessment, and evaluation in home health are also called “short term” RN visits.

Home health nurses keep a journal of each patient’s condition

Home health nurses are entrusted with the patient’s well-being, driving to their home to provide care. Home health nurses often serve as live-in caregivers, using critical thinking techniques they would use in the clinical setting. They monitor the patient’s vital signs, pay attention to complications, and follow a physician’s orders for home treatment. Home health nurses keep meticulous records of each patient’s condition.

When documenting care, home health nurses must remember that written records are admissible in legal proceedings. A nurse’s written records include every patient’s condition, as well as those related to her scope of practice. As a nurse, you should involve the patient in the record-keeping process, and ask for their input when developing the plan of care. The patient should also sign the journal, which contains important information about their medical condition and lifestyle.

SN in home health skilled nursing

RN, LPN or LVN-level nursing professionals provide skilled care to patients in their homes. Each visit requires the completion of detailed nursing notes. Medical documentation is required to support the skilled level of care, including the patient’s current medical status, medical equipment needed, and the estimated period of in-home services. A physician’s approval of the RN or LPN must be granted, which is based on the unique medical condition of the patient and overall safety.

Medicaid-enrolled individuals are typically furnished with services through a network of contracted MCOs or providers. Providers must confirm eligibility prior to rendering services. They may require a referral or prior authorization from the Medicaid program. Moreover, providers must follow the state and federal regulations as well as the MCO’s provider’s manual. These guidelines are necessary for the care of Medicaid-enrolled patients.

Depending on the situation, intermittent or part-time home health skilled nursing services are reimbursable. If the patient can’t make the required supervision visits, the RN or home health aide may be substituted by a skilled therapist. However, Medicaid doesn’t reimburse intermittent or part-time home health skilled nursing visits without proper supervision. A physician’s visit must be a critical part of the patient’s overall care.

Unlike inpatient care, participants must be under the care of a licensed practitioner. The practitioner may be a physician, nurse practitioner, clinical nurse specialist, or a physician assistant. The practitioner may be a private physician or one who works on the staff of a home health agency or ALF. A physician can also be a part of a hospital-based home health agency.

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