Plotting Visits

Plotting is where medical necessity turns into a schedule. A frequency that does not match the patient's skilled need is a denial waiting to happen, and a schedule that ends without a discharge visit creates work for someone else later.

Availability

We are available to the company 8:00 am to 5:00 pm. Some patients prefer mornings and some prefer afternoons — build the schedule that works best for your driving, but expect to compromise on times for some patients.

The quickest way to build a day is My Patients → Display Schedule, which lists everyone assigned for the day with names, addresses, and phone numbers.

When do RNs plot visits?

• OASIS visits — SOC, ROC, recertification
• When case managing

Standard frequencies

Observation, assessment, and education

• Preferred frequency: 3w1, 2w2
• Maximum of 3 weeks for observation, assessment, and education
• One visit a week is not medically necessary on its own
• Education visits are plotted Tuesday / Thursday unless the patient conflicts

What justifies extending the frequency: abnormal or fluctuating vital signs, weight changes, edema, symptoms of drug toxicity, abnormal or fluctuating lab values, respiratory changes on auscultation.

Front-loading

Front-loading is required to prevent hospitalization. An RN should be in the home within the first week of the start of care.

The highest-risk window in an episode is the first few days after a hospital discharge. A schedule that puts the first nursing visit on day six is a schedule built around convenience rather than risk.

Wound care

• RNs must be in the home at least every two weeks for any patient with a wound.
• If the patient has an extensive wound, no caregiver to perform the wound care, and cannot perform it themselves, you may plot the patient out for their entire certification period. The last visit plotted should be a recertification to an RN, at which point the RN decides whether the patient can be discharged or recertified.

Catheters

• Catheter changes are performed monthly.
• More frequent than monthly must be justified and ordered by the physician.
• A patient on service for catheter care only: 3w1, 2w2 for catheter care teaching, then the frequency changes to monthly for catheter changes.

The last visit is always a discharge

Whatever else the schedule contains, the last visit plotted should be a discharge.

Which discharge depends on who is involved:

Leaving an episode with no discharge visit plotted means someone discovers it after the fact, usually under time pressure, usually at month end.

Moving a patient to another day

To even out your days, or when a patient asks:

1. My Patients → the specific patient
2. Details on the visit you want to adjust
3. Change the target date at the top
4. Confirm it still says the right visit type

Then check the spacing. A 3×/week patient needs Monday, Wednesday, Friday — never three days running unless it is a holiday week.

When the schedule looks empty

If a patient's visits are low and nothing further is scheduled, tell the office. We may be waiting on authorization from insurance. Do not assume the gap is intentional.

Before you finish plotting

• Frequency matches the documented skilled need, not habit
• RN in the home within the first week of SOC
• Wound patients seen at least every two weeks
• Wound care days match the standard pattern
• Education visits on Tuesday/Thursday unless there is a patient conflict
• Last visit plotted is a discharge, of the right type
• Anything above standard frequency has an order and a documented reason

Related

• Skilled Need — The Coverage Test
• Frequency and Duration — How to Write It