Page 21 - Homecare Homebase: Skilled Nursing Training Manual

o CFM writes a “Need for Continued Care” coordination note.
o Scheduler applies Recert (02) service code.
o Clinician completes the Recert (02) visit and plots the visits for the new episode.
o Clinicians syncs
o CRM reviews recert documentation
o Scheduler assigns out new episode calendar
If the PRNs were not used during the first cert period, they will not be carried over to the new cert period.
• If a discharge decision is made by the CFM:
o The scheduler schedules the 18 service code
o Clinician completes the 18 visit to discharge
o Clinician syncs
o CFM reviews discharge documentation

Transfer to Inpatient Facility Process

*** ALL patients will be placed on Interruption of Care regardless of insurance. (Do
not DC managed care cases that transfer to an inpatient facility)

Clinician is notified of patient hospitalization.
Visit on tablet:
o Start the visit
o Press visit actions and you will be taken to the “Unexpected Events Screen”
o Choose Transfer to an Inpatient Facility on Unexpected events screen

o Press Continue
o The 11 will turn into a 44
o Complete a 44 Visit
o Input hospital Hold Coordination Note
o Sync
Visit NOT on tablet:
o Write a hospital hold order for visit
o Sync
o Your manager will approve the hospital hold order
o Your PSC will schedule a 44 Visit
o Sync

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10/1/2018