Help staff get recerts back on time
NJ agency’s compliance rises from 56% to 93%
Too few recertifications were returning within two weeks, and Lourdes Home Health Services of Collingswood, NJ, decided something had to be done.
"We looked at the current process and why it wasn’t working," says Ann O’Malley, RN, BSN, director of performance improvement.
Only 56% of the recertification forms, which are needed to continue service for Medicare patients who have been in home care for 62 days, were being returned within 14 days. Many took three weeks or longer, and the agency’s performance improvement team decided that was an unacceptable outcome.
So a task force was formed, and it conducted a four-month PI project that has resulted in 93% of the recertifications being returned within 14 days. O’Malley says the PI team will continue to monitor recertification compliance, with a goal of having 98% returned within two weeks.
The agency achieved its improvement by listing problems, and finding solutions for each one. These were as follows:
Problem: Sometimes the recertification form listed the wrong nurse. So it was sent to the wrong person, and that nurse might delay giving the form back to the clinical records department. This could slow the process down by days or even weeks.
Solution: The agency told nurses that if their names were incorrect on the forms, they had to return the form immediately to the clinical records department. Then the clinical records worker had to give the form to the supervisor of client services, who would correct the error in the computer. Finally, the new recertification would be sent to the correct nurse. The nurses were also instructed that when they received cases from another nurse, they had to do a computer change form so the correct nurse’s name would be on the case file.
Problem: Physicians sometimes would not sign the forms for days, again delaying the process. By the time the records technician called to remind the physician, a week might have gone by.
Solution: The agency places a sticky note on each form asking the physician to "Please sign, date, and return form within 48 hours." And the supervisor of clinical records calls tardy physicians at least weekly to remind them to return the forms. Also, there are a few physicians who have high patient referrals, and an agency courier regularly visits those offices. "So the clinical records person would drop off forms one day and then pick them up at the end of the week," O’Malley says.
Problem: Occasionally nurses would return the form to the clinical records department instead of having the supervisor review the recertification first. This became a problem because sometimes nurses might forget to document certain items on the form, and then the form would have to be recirculated before it could be processed.
Solution: Now the supervisor has to initial the form before it is sent to the clinical records department.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content