Common Q&A

This page has answers to the most common questions and problems we hear about.  If you can't find your answer here, or want more information, feel free to reach out to us! 

Patient Scheduling and Events

My patient keeps cancelling visits 

Talk to the case manager or write a communication report and we will send this to the agency. The patient may need to be discharged for non-adherence. But they might also be going through a lot, so it's best to decide with the blessing of the agency and care team.

I can't contact my patient

If you're struggling to reach a patient, they may not recognize your number, might be confused, or unfortunately something could have happened.  Sometimes it's even just bad timing.  So feel free to document a communication report on the patient's record and Lifespan's Unable to Reach team will start tracking and working to support you. Other tips we have include:

• Call back-to-back

• Try texting

• Leave a detailed voicemail (and regularly clear your  voicemail so you can receive return calls!)

• Try calling later

• Use emergency numbers

I want to order DME for a patient, how do I do that?

Durable Medical Equipment (DME) can be ordered by submitting the DME Request form linked on this site.  When you fill out this quick form, paperwork will be generated and sent to the agency to process.  The agency will need to obtain signed paperwork from the patient's physician and will then provide this to a DME supplier.  Depending upon how quickly this is done, orders may take anywhere from a few days to a few weeks to process.  If you have a patient who needs equipment urgently, please contact the agency or discuss options with the family for purchasing this equipment privately.  A list of equipment with prices and links can be found here.

My patient is going out of town

If your patient is going out of town, the timeframe is important.  If it is just for a short duration, that is not a problem. You can either document missed visits or a hold order (a Therapy Order stating the date services will be placed on hold and the date they will resume).  If the patient will not be returning for a significant period of time, it may be more appropriate to discharge them.  First, however, you should document a Communication Report and perhaps even give the agency a call to coordinate.

My patient is refusing services

If a patient is refusing services after  being evaluated, they will need to be discharged.  If you have confirmed they are not just refusing one visit, but all services, you can document a non-visit discharge (PT, OT, ST, MSW) or a missed visit (PTA, COTA).  If the patient is refusing services prior to being evaluated, you can document a Therapy Order detailing that the patient has refused and the physician ordered service will not be rendered.  

I would like this patient restaffed

If you only need one patient restaffed, whether it is because your schedules aren't meshing, you can't meet the patient's needs, or otherwise -- feel free to send a message on the app using that patient's thread.  The schedulers will immediately look for coverage.  Two caveats, however.  First, please let us know why you are requesting the restaff. This allows us to find someone who will meet the needs of the patient. Second, if you need multiple patients restaffed, due to personal circumstances, it may be better to reach out to coverage@lifespanpt.com so that the team can ensure all patients have coverage. 

My patient appears to be in distress / who do I contact during an emergency?

If a patient is in distress due to a medical condition, please call 911.  Home health agencies are not urgent care providers, so they will want to know, but will not be able to help in the immediate.  They will appreciate a call and an Incident Report documented on the patient's record.

If a patient is in distress due to their living environment, please keep in mind that you are a mandated reporter for Adult Protective Services (APS).  This is for real or suspected abuse. You can contact the agency to let them know that you will be filing a report to APS.  

• San Diego County: 800-339-4661. Fax:585-495-5247

• Riverside County: 800-491-7123. Fax: 909-338-6718

• San Bernardino County: 877-565-2020. Fax: 909-338-6718

• Imperial County: 760‐337­‐7878

• Los Angeles County: 877-477-3646

• Orange County: 800-451-5155

My patient went to the hospital - now what?

If a patient reports going to the hospital for 24 hours or greater, please document.  Depending upon the timing, this may be in a communication report or missed visit note.  We will inform all relevant parties.  Once/if the patient returns, we will reach out to you to re-evaluate them.  

I don't know if my patient was in the hospital for 24 hours or greater. What do I do?

In the case that you are unsure, and perhaps the patient is a poor historian, we can ask the agency to confirm.  They will receive hospital discharge paperwork allowing them to confirm the admission.  Home health and hospital services cannot both be billed, so it is important that you discontinue treatment until this has been confirmed. 

I can't obtain a digital signature because there isn't service

No worries, while most of our service area is connected via cellular data, that doesn't it all is.  If you can't get a signature in the home, there is a companion app for TherapySync EMR called TS Swift which you can download.  More information is available here.  

Can I just get signatures on paper/route sheets?

For ease of billing, as well as fraud prevention, we request that all clinicians obtain digital signatures.  This can be done by opening the visit note in the home and having the patient sign.  Or, if you do not have internet in the home, using the TS Swift app. 

I'm late for an appointment, what should I do?

For the most part, patients should be understanding if you communicate with them.  Feel free to call them and advise you are on your way, but had an appointment run over time.  If you find you're often rescheduling appointments, you may need to set up appointments with more buffer time.  

Can I schedule a patient for consecutive visits?

In general it is best to space visits out.  So if there is a frequency of twice per week, see them on Monday and Wednesday or Tuesday and Thursday.  This allows us to assess the patient over multiple days to intervene when problems appear and prevent hospitalizations.  However, if the patient has a very high frequency or a very limited schedule, you may need to schedule consecutive or 'back to back' visits.  It is best practice to document a communication report to explain why these are occurring, but is not banned.

How long do I need to stay with a patient?

Visits should be around 45 minutes in length.  Evaluations and Start of Care visits are likely to take a bit longer.  The most important thing, however, is that you are speaking with your patient to have a comfortable understanding of their psychosocial state and needs, assessing them visually through the performance of activities, providing skilled care in the form of both hands-on training (HEPs, transfer training, diet modifications, etc. - as appropriate for your discipline and the care plan) , providing verbal skilled care in the form of patient-specific education, and complying with all infection control requirements.  With this, you should find that your patients are reaching their goals while maximizing their safety and independence after home health has concluded.   

My patient's vitals are outside of parameters, what do I do?

If a patient's vitals are outside of parameters but the patient is not in any distress, it may be appropriate to simply call the agency and/or MD to report.  This can be documented on the patient's chart.  

However, if the patient is concerning you, it is best to call 911 and get emergency services.  If the patient refuses 911, you may be confused about what to do next.  In this case, it may be necessary to call 911 anyway and inform the patient that you are ethically bound to provide them with emergent services in this situation, but they may refuse when EMTs arrive.  If the patient still wishes to refuse, they can do so.  However, they may worsen to the point of unresponsiveness or even become more compliant when faced with the second opinion of the EMTs.  

Lifespan Therapy App and Caseload

Why do you need my availability on the app?

Availability on the Lifespan Therapy app is used to market for your coverage areas and also to offer you cases.  If we see that your schedule is full, we will not market for your area and will not offer you more patients until you have indicated that you have openings.  For these reasons, we greatly appreciate you keeping your app availability accurate! 

Do patients get offered at a certain time?

No, patients are sent to us at all hours. For this reason, we greatly encourage you to keep notifications on so that you are able to accept patients that are a perfect match for you!

Offers keep disappearing

Rather than annoy you with a message any time you don't get assigned to a case, the Lifespan Therapy app will just remove the offers of patients you do not get assigned to.  If you find that you are not getting as many patients as you would like, please let us know and we would be happy to review the situation.  

I want to change my coverage areas

To change your coverage areas, simply open the 'More' menu on the bottom right hand corner of the app and visit the 'Define Coverage' page. This will allow you to select zip codes you are interested in.  If you would like to define your coverage beyond this, please feel free to write this into the notes that pop up when you set your availability, also located under 'Set Availability' from the 'More' menu. Details like 'nothing below the 94' or 'looking to stay around 20 visits per week' allow the schedulers to tailor an experience to you. 

I'm not receiving notifications

Push notifications can be enabled in your system settings so that you receive notifications for messages and new patients.  

I want more patients or I'm not getting the caseload I would like

Lifespan has thousands of contracts with home health agencies, so if you are not getting the caseload you would like, this is very likely a solvable issue! Feel free to send a message to the Business Development department and they will talk to agencies who typically send patients in your area.  

If you are not receiving patients due to bans from agencies, patients, or other disciplines - this will be clearly identified to you.  In many situations, this should be resolvable and Lifespan would be happy to mediate or argue on your behalf.  However, if this is a matter of patient care and safety then please be aware that all necessary reports will be submitted to the agency and appropriate licensing board for investigative purposes and patients will not be offered.  

I am going out of town, sick, or unavailable - what happens to my patients?

You're human and that's ok! If you are unable to see your patients because you are sick, going on vacation, have an emergency, or otherwise - please just let us know so that we can restaff for your patients.  If you send us a message on the Lifespan Therapy app or write an Email to Coverage@lifespanpt.com 

I accepted a patient but it hasn't been sent to me on EMR

Very rarely there will be patients who were accepted but are delayed prior to their evaluation.  The scheduling team may be awaiting the patient's information to generate the record or the patient may be delayed pending their Start of Care completion confirmation.  The schedulers should stay in contact with you with updates via messages, however, if you are unsure please feel free to ask.

I'm struggling to arrange patients according to a timeframe

Setting your schedule is a difficult aspect of home health, but there are things you can do to make this easier.  Route planning apps are one option, allowing you to determine the best route to see patients.  It is also a good idea to avoid packing too many patients into a time frame.  For instance, if you have an eight hour block to see patients, you may have more luck with 5 or 6 patients than trying to fit in 8.  This will also give you time to document, make calls, and drive to patients.  Setting up small timeframes such as 4-4:30 instead of "exactly 4" can also help you to plan around unexpected events such as traffic.

Do I  have to see a certain number of patients?

No, you are not required to maintain a minimum number of patients to stay active in the Lifespan network.  While we hope to keep you happy and as busy as you would like to, we also respect your independence.  However, if you accept a patient, please see them through until discharge or let us know if you need them restaffed.

Do I have to work with a PTA/COTA? Can I work with a PTA/COTA?

Assistant coverage is entirely up to you.  All assistants must be in Lifespan's network, with a valid contract, but otherwise feel free to reach out to the schedulers to let them know you would like followups covered.  PTAs/COTAs are available in most regions where PT and OT coverage is.  If there is not an assistant available, the schedulers will work with you to either restaff the case or have you complete followups.

EMR (and charting)

I've forgotten my password

No worries, you can click the button to reset your password below the login screen or contact us to help get this reset.  

Do I have to see patients on the days they are plotted?

If you have accepted an Evaluation or Start of Care for a specific date, you can add a communication note if the initial assessment will be delayed. This allows us to keep the agency informed.  However, for followup visits you can simply move the visits around in accordance with the frequency and duration.  The workweek is Sunday-Saturday, so if there are two visits plotted, you can see the patient any two days that work without documenting a missed visit.

Can I make up missed visits?

Making up missed visits depends on many factors such as why the visits were missed, where the patient is in their episode, and even the patient's insurance.  For this reason, it is best to document your missed visits timely and thoroughly.  Lifespan will then coordinate with the agency to ensure they allow for making up missed visits and will then send you a message.

I accidentally started a note, how do I delete it?

Simply click on the scheduled date with a saved note and press the 'x' a the top right corner of the visit note. 

My patient's certification period is ending, what do I do?

When a certification period is ending, you have two choices.  You can either discharge the patient or recertify them.  If you are the only discipline staying on the case, you will need to complete a re-certification OASIS. If you are not, you will need to complete a re-certification Evaluation.  These both must be performed within the last 5 days of the episode.  You should coordinate either directly with the agency, or ask Lifespan to assist, so that you can ensure everyone is on board with your discipline continuing for another episode.  

Can I get a list of visits I've done?

Yes! TherapySync EMR allows you to run a report of all visits completed within a pay period under Time Charts (accessible through My Payroll after selecting 'View Records' next to any visit date).  Each link is custom so while we cannot share this here, Accounting would be happy to help you obtain your own personalized link.  

Can I get a list of cosigns I've done?

While there is no report for this on the clinician side, if you need a Lifespan administrator to run this report they would be happy to.  Please reach out to the Accounting department and they can get this information for you. 

I can't find my old visits. They seem to have disappeared.

One of the main reason why you may not be able to see a completed note is due to the fact that the cert period may have changed. To access you older notes just select the older cert period. Another reason may be due to the fact that the note might have accidentally been deleted. To retrieve a deleted note you can either submit an IT ticket with support or contact us to retrieve the note for you. 

What is the difference between a Non-Visit Discharge (NVDC) vs. a Discharge

A non-visit discharge is a discharge being done without a visit. You may need to document one if the patient is refusing further visits. The non-visit discharge is going to have just a discharge summary attached while an in person discharge will have a progress note and discharge summary attached. NVDC Documentation

I don't have signal, how can I obtain the patient signature?

Rather than obtaining this on paper, which does not protect you or comply with EVV requirements, it is better to use the TherapySync app.  Read More

Why do I have a "Mock Eval" assigned to me?

The Mock Eval is a placeholder and not a visit note. It is not anything that the agency will be downloading and making available to Medicare or Insurance company. It will have your name on there because you are the assigned supervising clinician. This is only for our EMR so we could enter the goals and for the goals to carry over to the follow up visit notes.

Patient had an incident however I was not around when it happened, patient only advised. Do I still need to document an incident report?

Yes, Incident Reports should be documented for both observed AND unobserved incidents.

How do I set the frequency? Does the agency set it for me?

Frequencies are primarily set with you, which you can document in the Verbal Orders section on the evaluation.  However, agencies, insurances, and other factors may impact the frequency and duration set.  Learn more on our Setting Frequencies page. 

Agencies

I can't reach an agency

If you are struggling to reach an agency, first try contacting them during normal business hours 8 AM - 5 PM M-F.  If you have an urgent matter or still cannot reach them, then something is definitely wrong.  In our many years of experience, agencies are readily available during business hours and have someone available on call.  So just reach out to us and we'd be happy to investigate.  

An agency is asking me to do something I disagree with

There are thousands of agencies and many employees at each agency, so occasionally you'll receive advice or requests that just don't sit well.  If you are asked to do something that you really don't agree with or perhaps don't understand, please feel free to reach out and we would be happy to act as a mediator.

When should I contact agencies?

Agencies are there for time-sensitive patient care questions or updates, as well as patient care decisions.  Examples might be: vitals outside of parameter, questions about nursing, or a disagreement between you and the patient concerning their care plan (discharge, frequency, activities).  

Feel free to simply document on the patient's chart for updates that are not time sensitive or do not require decisions, such as: patient preferences, hospitalizations, common missed visits.  Lifespan will ensure the agency is informed of all items placed into communication reports, therapy orders, and missed visits.

There are things agencies cannot assist with.  These include: EMR assistance, payment, restaffing requests.  Instead, feel free to reach out to Lifespan for these topics.

Documentation

Do I have to complete documentation in the home?

No, some clinicians prefer to completely finish notes in the home.  Others prefer to finish up after the visit or when they have returned home.  You will, however, need to obtain the patient's signature so you should always start the visit in the home.

How long do I have to complete notes?

24-48 hours is the recommended time frame for documentation completion.  In general, sooner is better. There may be orders, billing, co-signs, equipment, and otherwise that is held up by late documentation.  This can negatively impact patients.  Additionally, the quality of notes will decrease as time goes on.  This puts you at risk.  So enjoy the flexibility, but don't let it get out of control!

How can I obtain signatures for non-visit note paperwork?

TS swift is great for patient visit notes, but does not help with obtaining signatures for other paperwork such as NOMNCs and SOC OASIS consent forms.  These forms should be completed on paper or by using free digital signing apps such as Adobe Fill and Sign. 

How can I find consent forms for an SOC OASIS or non-OASIS SOC?

If you have accepted a start of care, you will be automatically emailed consent forms in your confirmation email.  If you cannot locate this, it is recommended that you check your spam folder and then reach out to us if need be.  Consent forms can be printed or completed digitally using apps such as Adobe Fill and Sign to collect signatures.  

What is a NOMNC?

A Notice of Medicare Non-Coverage (NOMNC) is a form completed to inform the patient that they will be discharged from home health.  Not just from your discipline, but from all home health services.  This form must be completed on the 2nd to last visit or 48 hour prior to the DC OASIS (home health discharge) so that the patient has time to contact the independent body, Livanta, listed on the NOMNC.  Our goal is to ensure the patient is agreeable to the discharge from home health so that they do not need to contact Livanta.  For this reason, it is important to discuss the plan of care with the patient and ensure they understand when they have reached their goals or plateaued, that they are in agreement with the goals, and that they understand what their next steps will be after home health to continue on their journey.  

How will I know if I need to complete the NOMNC?

Often we are not the ones obtaining the NOMNC, as nursing typically stays on the case longer than any therapy discipline.  However, in the event that you must obtain the NOMNC, this will be posted as a sticky note to the visit and we will send you an app message.  

How can I complete the NOMNC?

Locate the NOMNC in the patient's home health admission folder, print and bring along a copy, or complete the digital copy available on EMR under 'other forms' or within the visit note.  Simply add the date of Discharge, have the patient sign, and the NOMNC is complete! 

Do I  have to do a DC OASIS?

The discharge from home health is the final home health visit and per CMS guidelines must be assigned to the final clinician to visit the patient. As much as we would like to prevent you from having to do the DC OASIS, if you are the final clinician out you will need to complete this paperwork.  To assist you, we can obtain the SOC OASIS which will have many similar answers.  We are also happy to support you with any questions you may have. 

Will you tell me if I have to do the DC OASIS?

If we are informed of the DC OASIS we will plot this on EMR.  However, we are not always informed of this ahead of time.  Rather, using the process of elimination you should be able to understand if you are the last one out. Is the patient talking about  nursing visits for later in the week? It sounds like nursing is still on the case and will be the one to discharge the patient from home health.  Was this a PT SOC with no other disciplines? Well, then the only person who can do the DC OASIS is the PT. 

Other

I'm struggling to communicate with other therapists

Care coordination is an important aspect of treatment, so if you feel your phone calls and text messages are being ignored, please reach out. We'd be happy to help facilitate communication.  

I'm nervous - can I shadow another therapist?

We completely understand being nervous, especially if you are newer to home health.  However, Lifespan's network is meant for clinicians who are able to treat patients independently.  Unfortunately, we cannot offer shadowing.  Instead, we can provide resources and answer questions to help you feel more comfortable.  

Safety Precautions

If you have questions about how to protect yourself or handle unfortunate events, please visit the Safety Precautions page. 

Should I wear anything particular to the visits?

Close-toed shoes, for safety, and professional attire should be worn.  But otherwise, what you wear is up to you.  Most clinicians choose between scrubs and business casual clothing, depending upon what they will be doing with the patients.  

Why do I see "trackable therapist" on EMR?

A trackable therapist means that the evaluation or assessment was filled in from an outside entity.  We call these "takeover" cases, because you will be taking over the patient's care.  We aim to always be clear about the goals, frequency, and care plan to be followed.  The Evaluation will always be transcribed into the system to input the goals and the frequency will always be plotted so as to avoid confusion.  

How do I get paid?

Lifespan is proud to pay on time, every time.  However, as clinicians are independent contractors, they will need to submit an invoice to be processed prior to direct deposits going out.  Lifespan processes invoices after the end of each pay period, which go from the 1st-15th and 16th-end of the month.  An invoice template will be sent to you by the Accounting department with your rates, all necessary tables, formulas, and a unique EMR URL to pull your visit listings.

Please visit the Invoicing page for more information, or reach out to the Accounting department.