The Clinical Evaluation/LCD Visit is a place for the RN to document the patient’s clinical eligibility, based on the Local Coverage Determination for all Medicare Administrative Contractors (MACs).
While not required by CMS, the Clinical Evaluation/LCD Visit is an easy way for clinicians to gather the information necessary for the physician to write a detailed Certification of Terminal Illness narrative statement.
The Coordination of Care Note is for documenting phone calls, schedule changes, care conferences, non-patient care visits such as deliveries, and communication between members of the IDG, patients, families, physicians, pharmacies, and any others involved in the patient’s care delivery.
The patient's supplies and durable medical equipment (DME) are listed in the Patient Profile. View the Patient Profile by selecting Edit Profile in the Patient Chart.
Any DME or supplies listed on your agency’s DME List or Supply List can be added to the Patient Profile.
Best Practice recommends creating a Clarification Order for any changes to Physician Orders, as other IDG members may have already documented based on the original Physician Orders.
1. Convert the patient’s referral to Pending status.
Once a decision has been made to admit a potential patient, convert the patient’s referral to Pending status.
Click here for instructions on converting a patient’s referral to Pending.
2. Schedule one of the following tasks:
Once the patient is converted to Pending, you can schedule an RN Initial Assessment, RN Initial/Comprehensive Assessment, Coordination of Care Note, Clinical Evaluation/LCD Visit, Face-to-Face Visit, or Hospice Physician/Nurse Practitioner Visit.
Click here for instructions on scheduling visits/tasks.
Axxess Hospice has an Unattended Discharge Note and an Unattended Death Note for situations when a patient’s death or relocation is not communicated to the hospice in a timely manner.
A Discharge Summary or Discharge/Death Summary will populate from both of these documents.
If the patient is a live discharge:
Complete a Discharge Visit or Unattended Discharge Note.
On completion, the patient’s status will automatically be updated to Discharged, and a Discharge Summary will generate.
If the patient died on service:
Complete a Death Visit or Unattended Death Note.
On completion, the patient’s status will automatically be updated to Deceased, and a Death Summary will generate.
Select Patient Charts under the Patients tab in Axxess Hospice.
The menu bar on the left side of the screen provides a Status filter. In the Status drop-down menu, select Discharged to access charts of discharged patients, or Deceased to access deceased patient charts.
Select Medication Profile under the Patients tab in Axxess Hospice.
Find the patient’s Medication Profile using the Search box and/or filters on the left-side menu.
Available action items are provided for each medication in the Actions column on the far right.
Click Discontinue and Copy to discontinue the original order and create a new medication order modal with no start date.
Update the order as needed. (Clinicians can only update the parts of the order that are new e.g., medication frequency and dosage.)
This is an easy way for clinicians to update medication orders as needed, which can be frequent as conditions change near the end of life.
Under the Schedule tab, select Patient Schedule if changing a visit date for a patient visit/task. Select Employee Schedule if changing the date for an employee visit/task.
In List View, the Bulk Update button on the right side of the screen opens an editable view of the schedule. Users can change the date and/or assignee of one, several, or all tasks/visits.
Once the changes are made, the Bulk Update button changes to a green Save Bulk Update button. Click to save your changes.
In the Calendar View of the Patient Schedule or Employee Schedule, simply drag and drop a visit to the desired date to reschedule a visit/task.
Scheduling is based on User Permissions. Please consult your administrator/supervisor to discuss changing your permissions.
After completing an RN Initial/Comprehensive Assessment or an RN Comprehensive Assessment, selecting the Check Errors button activates the HIS error check.
The HIS error check analyzes the assessment for any CMS distributed fatal errors, warnings or inconsistencies, and alerts the user to any problems found.
Although the form can be completed without resolving the errors, it is highly recommended that the RN and Clinical Manager review and address the problems identified prior to submission of the HIS export file, to ensure accurate quality reporting.
After completing the RN Initial/Comprehensive Assessment or the RN Initial Assessment, the form is submitted to the QA Center for review. After the assessment is approved by QA, the Plan of Care will generate.
In the meantime, you can access a draft view of the Plan of Care Profile with the Problems, Goals, and Interventions identified on the assessment, and review the initial Plan of Care orders prior to QA approval.
The QA Center houses documents in read-only format.
If a document needs to be updated, the QA nurse can return the document to the clinician by selecting Return in the Actions column of the QA Center. The QA nurse can then send a message to the clinician outlining the specific changes needed. (Remember that information exchanged through the Message Center is secure and protected. Users can discuss information regarding patients, documentation, etc. without having to worry about their HIPAA-compliance being compromised. Messages sent through the Message Center are HIPAA-compliant.)