Personal Care Worker needs to fill out Application for Employment.
Patient/Patient’s Representative needs to fill out Client Intake Information.
- Receptionist
-Accepts Patient/PCW Application
-Checks for completeness
-Checks patient’s insurance
-Sends MD order/request for medical records to a physician (permission from MD for agency RN to assess patient)
-Once MD order/medical records received
-Informs HR when patient’s chart is ready and gives PCW application to HR
- Human Resource (HR)
-Performs criminal background check
-If the agency is able to hire PCW, HR contacts PCW to schedule orientation/conducts PCW orientation
-Receptionist creates patient chart and gives to Admission RN
-If the agency is unable to hire PCW, HR informs PCW and Receptionist will contact the patient to send new PCW to apply or offer agency PCW if the patient does not have another PCW to apply
- Admission RN
-Contacts patient to schedule admission visit
-Completes admission visit
-Completes patient’s chart
- Director of Nursing (DON)
-Audits Chart
-Creates a patient red folder
- Medical Records
-Submits 485 (Home Health Certification and Plan of Care) to PCP for approval
-485 details the actual hours and cares being provided by PCW services
- Prior Authorization Specialist (PAS)
-Submits PA to the insurance company for approval of PCW services
-Insurance will review and approve or deny PCW services
The process can take up to 30 days or more depending on verification.
- HR
-Once 485 is signed and PA is approved, HR is informed and PCW services can begin.
– Informs PCW to pick up the red folder and gives start date to start PCW services
- Supervisory Nurse
-Completes supervisory visits every 50-60 days and as needed.
(Supervises PCW and assess the need for continued PCW services)
– Renews 485 before the current one expires and writes MD orders as needed.
-Fill out PCSTs for insurance before requesting for a new PA for soon to be expiring PAs.
- Discharge:
-There are many reasons why a patient may be discharged, ie: per patient request, per MD request, per insurance denial, due to safety reasons, etc. (If the patient does not agree to be discharged a 10-day notice letter must be written first)
– Supervisory Nurse must complete all discharge paperwork within 30 days.
*At any point during the application process if Highlander Home Health Care feels the patient does not qualify for PCW services, we will inform the patient immediately.