Transfer and Discharge Notices These forms are required to be given to the Medicare fee-for-service patient/client in the following situations: • Advance Beneficiary Notice (ABN) – When the patient/client no longer meets Medicare coverage criteria, e.g., is no longer homebound. • Home Health Change of Care Notice (HHCCN) – When services or supplies are changed or decreased, e.g., the physician and/or non-physician practitioner discontinues wound care services earlier than expected. • Notice of Medicare Non-Coverage (NOMNC) – Two days prior to discharge to provide the patient/client with information to appeal the discharge. Review the following policy and procedure: Online Bookmark Title of Policy Assessment (PE) Patient/Client Transfer and Discharge Notices Documentation Documentation Guidelines in Home Care The home health record is a written account of the patient’s/client’s history, status, and progress. It contains a plan of care (orders), patient/client care forms, and business and financial data. Documentation and Standards • The record is the data base for planning individualized care for the patient/client and serves to communicate information to all health professionals involved in the patient’s/client’s care. • It serves an important legal function. It documents evidence for the patient’s/client’s care. • It also serves an important financial function. It documents evidence for patient’s/client’s insurance claims, including Medicare. • It serves to protect the professional and the Agency from liability issues that could result in loss of licensure. The phrase “if it was not charted, it was not done” reminds us that the best evidence of an event is usually what is in writing. Because most malpractice claims occur long after the events take place, when recollection can be unclear, the written record is given great significance. The written record can be the best indicator of what actually happened because it was written at the time of the event.
