OASIS /BILLING QUESTION
This patient had an episode dates ranging 1/21/17-3/21/17. The nurse did a Recert visit on 3/19/17 and then was unable to see patient again due to hospitalization on 3/23/17. New Recert episode dates are 3/22/17-5/20/17. So basically since Recert visit was completed a new Recert episode opened and patient was hospitalized before any further visits could be done. What would be the best way to handle this situation:
1. Put hospital hold in new Recert episode for 3/22 and resume patient on 3/24 or
2. Discharge remove Recert and put a DC instead and open new episode for resumption on 3/24?
3. Plot non billable discharge for last date of episode and open new episode for the ROC date?
Is it true you cant make ROC your first billable visit? So option one is out? However CMS does not want us to DC and do SOC, right?
Any link related to this situation from CMS will be appreciated. Thank you
1. Put hospital hold in new Recert episode for 3/22 and resume patient on 3/24 or
2. Discharge remove Recert and put a DC instead and open new episode for resumption on 3/24?
3. Plot non billable discharge for last date of episode and open new episode for the ROC date?
Is it true you cant make ROC your first billable visit? So option one is out? However CMS does not want us to DC and do SOC, right?
Any link related to this situation from CMS will be appreciated. Thank you
Comments
Vicki L. Betts, RN, HCS-D ICD-10, HCS-O
Clinical Assessment Manager
Amedisys Home Health Savannah Hub
190 Westside Drive
Suite E
Douglas, GA 31533
PH: (844) 836-5213 Cisco Ext# 5007
FX: (229) 868-2317
vicki.betts@amedisys.com
www.amedisys.com
The HHA will not know if the assessment is a SOC or ROC until the HHRG is calculated. If the HHRG score is exactly the same and the recertification HHRG, the care is considered continuous. If the HHRG score is not exactly the same as the recertification HHRG, the care is not considered continuous and the agency must complete an internal agency discharge followed by new SOC. See Oasis Answers 2017 pg 650.
Thank you,
Rebecca Flores, RN, BSN, COS-C
Home Health Clinical Mentor
661 N. Prospect
Porterville, Ca. 93257
Office 559-782-7670
Fax 559-782-7674
Work cell 559-981-0733
and their status when they return." This is one of the scenarios that is
handled in a FAQ. It was updated in Nov 2016 (previously in 2010) and you
can find it at:
http://www.oasisanswers.com/downloads/oasisconsiderationsforpps_11.02.07.pdf
I HIGHLY recommend EVERYONE print this out and keep it handy till you learn
it because it clears up several tricky OASIS timing questions.
It is a bit confusing, but here it is:
11. Patient receives a recertification assessment during days 56-60, and
then experiences a qualifying inpatient admission in the new episode. o No
visits made in the new episode prior to inpatient admission.
Note that there is a change from the 2010 version. It used to say that
transfer without discharge was preferred. I am curious why it no longer
says that.
Answer:
at recertification: (M0100) RFA 4. At (M0826) enter number of therapy
visits indicated for the subsequent 60- day episode, or enter 000 if no
therapy visits indicated.
at admission to hospital: Transfer with/without HHA discharge (M0100) RFA 6
or 7
If RFA 7 was completed, a new Start of Care (M0100) RFA 1 is completed upon
patient’s return home.
If RFA 6 was completed, a SOC/ROC comprehensive assessment is completed.
(The HHA will not know if it is a SOC or ROC until the HHRG is calculated).
If the new HHRG is exactly the same as the recertification HHRG, the care
is considered continuous. M0100 should be reported as RFA 3 and the
assessment is a Resumption of Care. (This is an example of when the first
visit in the new certification period is a ROC visit.)
If the new HHRG is not exactly the same as the recertification HHRG, the
care is not considered continuous and the agency must complete an internal
agency discharge (no D/C OASIS required). M0100 should be reported as RFA 1
and the assessment is a Start of Care, starting a new episode/certification
period. New admission paperwork is not necessary, except as required by the
payer or agency policy.
Daniel P. Clark, RN
My previous response is essentially correct, but i linked to an old
version. I saw the date ending in '7' and thought it said '2017'. It
actually said 2007. The link below is from CMS and they still have the
2010 version. My deepest (and very embarrassed) apologies.
Please see SCENARIO 12 instead of 11 in my previous response.
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/OASIS/Downloads/OASISConsiderationsforPPS.pdf
You can verify this is the most current version at
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/OASIS/OASISPPS.html
12. Patient receives a recertification assessment during days 56-60, and
then experiences a qualifying inpatient
admission in the new episode.No visits made in the new episode prior to
inpatient admission.
at recertification: (M0100) RFA 4. At (M2200) enter number of therapy
visits indicated for the subsequent 60-
day episode, or enter 000 if no therapy visits indicated.
at admission to hospital: Transfer with/without HHA discharge (M0100) RFA 6
or 7, dependent upon plan for patient return to agency or plan for
discharge. (RFA 6 - Transfer without discharge is RECOMMENDED)
• If RFA 6 was completed, a SOC/ROC comprehensive assessment is completed.
(The HHA will not know if it is a SOC or ROC until the HHRG is calculated).
• If the new HHRG is exactly the same as the recertification HHRG, the care
is considered
continuous. M0100 should be reported as RFA 3 and the assessment is a
Resumption of
Care.
(This is an example of when the first visit in the new certification period
is a ROC visit.)
• If the new HHRG is not exactly the same as the recertification HHRG, the
care is not
considered continuous and the agency must complete an internal agency
discharge (no
D/C OASIS required). M0100 should be reported as RFA 1 and the assessment
is a Start
of Care, starting a new episode/certification period. New admission
paperwork is not
necessary, except as required by the payer or agency policy.
If RFA 7 was completed, a new Start of Care (M0100) RFA 1 is completed upon
patient’s return
home.
Daniel P. Clark, RN
Thank you...
the visit differently from a clinical perspective, but the M questions are
identical. I believe that is the reason fro M0100.
Daniel P. Clark, RN
"Transfer without discharge" is recommended in the 2010 version, and the
relevant scenario is #12.
The 2007 version did NOT say it was recommended. That scenario was #11.
I think the intent (of both 2007 and 2010 versions) in your particular
instance is the same.
I hope I haven't caused too much confusion.
Daniel P. Clark, RN
Thanks. It looks like they added that from 2007 to 2010. Appreciate your input.