Skilled nursing visits on the same day as hemodialysis

Can skilled nursing conduct a routine visit on the same day patient receives hemodialysis? I am concerned about duplication of services. This is traditional Medicare patient. Thank you in advance for your insight.


  • edited May 2017
    I don't unless it is something that dialysis nurses aren't doing, such as wound care or if patient has a need for IM injection (not related to ESRD), help with medications once at home, etc. Just an assessment for evaluation I think is duplication because the hemodialysis nurses do assessments before and after treatment. I have had dialysis patients call the after hours nurse at 11pm asking for a prn visit due to a fall or feeling extremely weak,(on same day as they did dialysis) and we would do a visit then too. I don't have any regs to quote, it's just how we do things where I work. Best to err on the side of caution.

  • Yes they can be seen. It really is a shame that Dialysis centers only do Dialysis. So if your skill is wound care, it happens all day everyday. They only do Dialysis so if you aren't a Home Dialysis and your patient qualifies for services, you are good.
  • edited May 2017
    We also do not do a visit on the same day unless the appointment they are going to is unrelated to our specific order, such as wound care or IV care visit that is not also being addressed by the appointment they are going to..

    Deborah L. Falen

    Home Health Office Coordinator

    Ellwood City Hospital HHA

    724 Pershing Street

    Ellwood City, PA 16117

    phone 724-758-2730

    fax 724-752-4216
  • Thank you for your input. I've heard some agency denied payment after ADR. The agency performed routine nursing visits on the same day as patient would receive hemodialysis. The current case that I am worried about doesn't have orders for wound care or injection. Routine Sn, PT, OT post SNF. Patient is being discharged on Saturday, but goes to dialysis m, w, fri. Our Soc is projected for Monday, the same day as dialysis. I want to reschedule for Tuesday, but referring source insists on Monday.
  • edited May 2017
    It depends on what you mean by a "routine" visit. If you mean a SOC with
    just enough teaching and assessments that you believe it will technically
    be okay, then you have reason to be concerned. Many nurses seem to be
    incapable of charting well enough to convince an auditor that the service
    was necessary to be done on the same day and that the other entity couldn't
    have done it. Focus on the questions: What is my skilled need for this
    visit? Is it justified? Is there a good reason for doing this on Monday
    vs Sat or Sun? Can I convince an auditor 2 years from now that I am right?

    As far as I know, there is nothing in the regulations that prevents the two
    services from being on the same day. But, if the skilled need you will be
    addressing could/should also be addressed by Dialysis, then I would find an
    alternative. Wound care, injections, IV's, etc make for easy reasons to
    justify the visit. The Dialysis facility will not get paid to do those
    things because they are not set up to do them.

    Daniel P. Clark, RN
  • RN may visit, if the RN will be performing care that was not capable of being performed during dialysis visit. For example- if patient had a wound with NPWT Wound vac, and HD RN not able to perform, the Home health RN would be expected to visit.

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