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Home Health Articles

Pulse Home Health Care practices skilled health care procedures firmly rooted in the latest research and best practice policies. We routinely mail bulletins to physicians and other medical referral sources to highlight how we help patients and to explain the scientific basis for different services. Here we share selected physician bulletins about Pulse's Home Health Services. If you have questions about how home health could help you, please contact us today.

Documenting Skilled Need

New Requirements

In 2011, new face-to-face encounter documentation rules require doctors to comment on the home health patient’s skilled need – in the doctor’s own words.  Many physicians and their staff have heard conflicting stories about Medicare’s skilled need requirements.  Medicare and most other insurances require the presence of a skilled need before covering services under home health benefits.  However, some misconceptions about the application of this standard exist.  Please allow Pulse Home Health Care to provide a brief, real world clarification.  Understanding skilled need can prevent frustration for doctors and case managers as well as open possible avenues of treatment for deserving patients. 

In general, skilled need means that treating the patient requires the expertise of a registered nurse, physical therapist, or speech pathologist.  While doctors can include home health aides (HHA) or occupational therapy (OT) as part of the plan of care, the HHA or OT services alone do not justify a home health episode.  In addition, CMS does not recognize med set-up or pre-filling syringes as a skilled need.  Some services fit the skilled need definition based on complexity alone (i.e. wet-to-dry dressings or gait training).  In other cases, the condition of the patient may cause a normally simple activity to require the attention of a nurse or therapist.  For instance, a patient has a normal, plaster cast but has a pre-existing peripheral vascular disorder that heightens the chance of circulatory problems associated with the cast.  While not all patients with a new cast would need home health, this patient could benefit from RN teaching and assessment for complications. 

When the Family Can Help: Nurses often teach family and other caregivers to perform wound care, injections, assessments, etc.  However, the presence of caregivers does not negate the skilled need.  Nursing services would still be appropriate for times when caregivers are not available.  In addition, our nurses will continuously assess the capability and willingness of caregivers.  When trained caregivers or patients demonstrate unwillingness or incapability for wound care, assessments, or other important health care activities, our nurses will increase services/frequency to fill the need.

Injections: IV, IM, & SQ injections, on a short-term basis, generally meet the skilled need requirement. When your patient has a continuous, long-term need for injections, home health can help long-term if the patient meets homebound criteria and cannot be taught to perform the injections independently. 

Catheters:  Insertion of and care around Foley catheters also meet the skilled need standard.  Even when your patient has a long-term need for assistance with Foley catheters, we will serve your patient. 

Teaching & Training: Teaching & training that should be done by a nurse usually constitutes a skilled need.  Doctors commonly order teaching for:

  • Wound care
  • Medication administration
  • Bowel & bladder training
  • Newly diagnosed diabetic cases
  • Preparation & maintenance of therapeutic diet
  • ADLs where special techniques or adaptive equipment are required due to a loss of function

Even when nurses have performed teaching in the controlled environment of the hospital or doctor’s office, CMS recognizes that the transition of the patient to a home environment can create the need for reinforcement or new teaching.


Please offer Pulse Home Health Care to your patients.


2325 Severn Ave, Ste 5 Pulse Home Health CareMetairie LA 70001 Pulse Home Health Care(504) 831-7778

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