Tina M. Marrelli, MSN, MA, RN, FAAN

Tina M. Marrelli, MSN, MA, RN, FAAN is the Chief Clinical Officer for e-Caregiving Solutions (www.e-Caregiving.com) an e-based family/friend educational system. Marrelli is the President of Marrelli and Associates, Inc., an international health care consulting firm which has been in business for over 20 years. Ms. Marrelli has an extensive background in management, practice, operations, performance improvement, payment and regulatory policy. Tina offers expert and comprehensive consulting services in home care, hospice, and hospital organizations and other settings and businesses, with special emphasis on clinical, compliance, regulatory, software implementation and systems analysis. Marrelli offers care and care planning tools and content to a select group of software vendors. Tina is especially interested in transitions of/in care models. This area can be a challenge all involved – for older adults and their family caregivers as well as for hospitals and other organizations discharging people back to home, skilled nursing facilities, rehabilitation centers and other care settings. If you are seeking to review and improve transitions of care and related processes at your hospital or other organization, Tina can be contacted at news@marrelli.com. Authored publications that communicate the depth and scope of management include:

  • The Handbook of Home Health Standards and Documentation Guidelines for Reimbursement, “The Red Book” (2018, 6th edition)
  • A Guide for Caregiving: What’s Next? Planning for Safety, Quality, and Compassionate care for Your Loved One and Yourself” (2018)
  • The Nurse Manager’s Survival Guide (2018, 4th edition)
  • The Hospice and Palliative Care Handbook (2018, 3rd edition)
  • Home Health Aide: Guidelines for Care
  • Home Health Aide: Guidelines for Care Instructor Manual

Tina is a prolific writer and serves as an editorial board member of The American Nurse as well as the Journal of Community Health Nursing. Tina is also an Editor Emeritus of Home Healthcare Nurse/Home Care Now. Tina received a Bachelor’s degree in Nursing from the Duke University and a Master’s in Health Care Administration and a Masters in Nursing. Tina also worked at the central office of the Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid (CMS) for four years in the areas of home care and hospice policy and operations, where she received the Bureau Director’s Citation. She also served on the National Hospice and Palliative Care Organization’s (NHPCO) Standards and Accreditation Committee, has been the recipient of the Arizona Association for Home Care’s prestigious Genie Eide Award, and served as a member of the Hospice and Palliative Nurses Association’s “National Competency Project” which wrote and published the first standards for hospice nurses. Tina also served as a Reviewer for the 2014 Scope and Standards of Practice Home Health Nursing (2nd edition, 2014 American Nurses Association).

Consultative Services

The team at Marrelli and Associates, Inc. provides product development and process improvement services to many diverse organizations which includes home health, hospitals, universities, publishers, hospices, software firms and other organizations for various assessments and interventions. Examples include management training, compliance assessment considerations, accreditation assistance, quality initiatives, orientation development and services, daily operations, retention and recruitment programs, implementation of documentation systems, written product development and case management models. Tina can be contacted directly by e-mail at news@marrelli.com. This experienced team of consultants assists client organizations in meeting the daily challenges as well as identifying those looming on the horizon. Our services are multi-faceted and the list of services is extensive, and usually based on a comprehensive organizational review. While tackling a broad range of complex issues, both nationally and internationally, we seek to exceed client expectations by engaging the expertise of industry leaders in specialized health care services.

Hospice Regulatory and Compliance Expertise

Tina has been working in hospice since its inception and was on the panel that defined the first hospice nursing standards. Tina’s team of experienced hospice leaders can provide your organization with the specialized knowledge to succeed. This includes due diligence activities, compliance activities such as reviews, documentation and coverage assessments and presentations based on findings, and more. Whether you need an accreditation related review pre-survey or help after a survey, pre-audit assistance or post-audit help, compliance assessment or compliance program development, this specialized team brings a wealth of real-world operational, regulatory, and compliance expertise.

Put our extensive experience to work for you!

  • Providing comprehensive operational/clinical assessments
  • Preparing for accreditation, including comprehensive surveys
  • Development and implementation of clinical paths
  • Compliance assessment and programs
  • Quality monitors
  • Customized conference and presentation planning
  • Orientation of new managers or organizational staff
  • Software and content design
  • Specialized reimbursement assistance
  • Performance improvement initiatives

Consulting Services –Some Lessons Learned

Let the experts at Marrelli and Associates review a sample of your organization’s medical records to give you peace of mind that your clinical documentation supports eligibility, coverage, quality and reimbursement standards. We are here for YOU!

To that end, there are two areas where agencies would benefit from closer scrutiny of the documentation to assure it supports Medicare home health eligibility and minimize risk in a post payment review situation:

  1. I would suggest agencies pay close attention to the code selection and sequencing that occurs by coders following the completion of the comprehensive assessment and development of the POC. I am seeing the coders recommending changes to M1021 (primary diagnosis) based upon hospital discharge information or based upon assessment information provided by the assessing clinician. These changes are approved by the assessing clinician, however when changed to a different primary diagnosis may not match the reason for the Face to Face encounter.  If this occurs the Face to Face would be invalid for supporting eligibility.
  2. Assuring that the primary diagnosis selected is the primary focus of care. The primary diagnosis should be clearly identified and defined in the comprehensive assessment meaning the current status of the condition is described as well as identification of the skilled interventions needed and desired by the patient. The plan of care should address goals and interventions specific to the assessed need and then continued assessment of the condition should be noted on subsequent visit notes as well as description of  interventions  and the patient/caregivers progress towards the identified goals. This level of documentation will support questions related to eligibility and coverage.  For queries, contact Tina directly at news@marrelli.com.