A6: Recommendation for Organizational Change A recommendation for change will be to create, implement, and mainstream an AIM program charting template that will capture all information for reimbursement of services. The deficiency of complete and thorough documentation has continued to be a challenge for Sutter being able to be reimbursed for AIM program services. Also, proper documentation of these visits will ensure that the primary goal of the program occurs. This goal is for the patient to manage their chronic disease in a manner that will provide them a satisfactory quality of life and prevent any unintended ER visits or hospital readmissions due to complications from the original chronic disease. When visits are thoroughly and accurately documented, reimbursement will occur. Also, the program will become truly valuable to the patient (B. Lawrence, Personal Communication, June 10, 2019). The charting template will format after all principles of standard nursing documentation. The six central components that need to be captured in each visit include AIM diagnosis (reason why patient is in the program), caregiver involvement, education provided during the visit, teaching tools provided to patient (and how they have implemented these tools into practice on a daily basis), a declaration of patient’s SMART goal (sustainable, measurable, achievable, relevant, time-based), and current progress made towards that goal.
C157 Task 1 Page 12 This template needs to be formatted in a manner that will capture the reasons for nursing documentation. These include communication with the healthcare team, legal documentation, regulation and legislation, reimbursement, research, quality process, and performance improvement (American Nurses Association, November 1, 2010). While the primary reason for this utilization will be for documentation worthy of reimbursement, each of these other crucial components listed above is also crucial factors that need to ensure thorough and proper documentation. The AIM diagnosis is crucial to the reimbursement process. Medicare and Medicaid regulations will only pay for services that are deemed relevant to preventing complications related to a chronic illness that has resulted in a previous hospitalization. If the diagnosis is not captured within the charting template, this is the first reason why reimbursement may be denied. Also, constant awareness of the diagnosis will set the stage for the creation of the rest of the care plan. It will also keep the Clinician aware of assessing for any future needs for home health services in the home should the patient experience a complication or worsening of condition (Center for Medicare and Medicaid Services, March 22, 2019). Caregiver involvement is of two-fold importance. First, it allows the Clinician to be aware of whether the patient requires extra services continually. For example, the patient may not have anyone in the home who can properly shower and care for their personal hygiene needs. In
- Spring '17
- SUTTER HEALTH