CLHFs (congregate living health facility) have become high on the scale for private insurers to want to deny claims submitted for reimbursements. So, as history has shown before, one of the ways that the private payers sit longer on their monies is to deny the claims based on the fact that the facility is unaccredited.
Joint Commission and CIHQ are the only two organizations thus far that offer a program for CLHFs, and while working on a facility and its accreditation, I became aware of these top three areas CLHFs struggle with in achieving compliancy to these.
These are the top three issues:
Often times when staff take care of patients that are on the vent, along with the trachs that they have, nursing staff will provide care to these patients that encompass many tasks. Tasks that range from changing the trach tube, suctioning, changing out equipment tubing, and an array of other tasks that are often times defined as "ventilator services". This goes without saying that this can ease the nightmare of additional documentation for the staff, which is fine so long as there has been a definition to the terms of ventilator services. "Ventilator Services Provided" is often the term used, and the terms that need to be defined in the nursing policy for the facility. A simple definition of what services it is that have been provided allows then the staff to continue to offer the abbreviated version of these services condensed into just these three words for simplex documentation.
The next area problematic has to do with the initial nursing assessment that is to be done within 24 hours of admission for new admits. In processing the new admission, it is common that the LVN will do an assessment of the patient in preparing the paperwork, she/he then assesses and then signs the document with time and date. But, here lies the problem: LVNs cannot make assessments of patients. This assessment is outside their scope of practice. So, the quick and easy work around this problem is for the RN to come review the patient, assess the patient, and determine if she/he agrees with the LVN documentation. If he/she does agree with it, then he/she will need to countersign the LVN signature with a new date and time, which must also be within the first 24 hours of admission.
The 3rd area has to do with the credentials verification and processing of your Medical Director and any other physicians, PA, RNPs that make rounds and take care of the patient in your facility. The primary source verification is the website of which you would verify their licenses, printing up the verification sheet for proof that you have checked their licenses. The second source verification is the verification through the AMA for the physicians. You need to have an account with AMA and pay the $40.00 per query. The query you run is the second source of verification that you need to run and print up for their credentials verification folders.
These resolutions to these three problems can be your sure win to assisting you at getting closer to that procurement of your accredited status for CLHF.