OASIS-C

1. OASIS-C Clinical Record Issues Contact: Cindy Skogen, RN (OEC) 651-201-3818, or health.oasis@state.mn.us for questions. Source: Center for Medicare and Medicaid Services Clinical Record Issues

2. M0080 Discipline of Person Completing Assessment • 1-RN 2-PT 3-SLP/ST 4-OT • Only one individual completes the comprehensive assessment: - If more than one discipline involved in case • Care consultation/coordination is needed • But only one actually completes &records assessment Clinical Record Issues

3. M0080 discipline of Person Completing Assessment (cont.) • RN & PT/SLP ordered at initial referral, the RN must complete SOC comprehensive assessment • LPN’s, PTAs, COTAs, MSWs, & HHAs not authorized to complete comp assessments • Last qualified clinician to see patient at DC completes the DC assessment Clinical Record Issues

4. M0090 Date Assessment Completed • (M0090) Date Assessment Completed: • _ _/_ _/ _ _ _ _ • Month/date/year • Actual date the assessment is completed • M0090 cannot be before the SOC date • If agency policy allows assessments to be completed over more than one visit date –M0090 =the last date-when the final assessment data is collected Clinical Record Issues

5. M0090 Date Assessment Completed (cont.) • Record date data collection completed after learning of event: • -Transfer to Inpatient Facility; no agency DC -Transfer to Inpatient Facility: patient DC from agency -Death at home • A visit is not necessarily associated with these events Clinical Record Issues

6. M0100 • (M0100) This assessment is Currently Being Completed for the Following Reason: Start/resumption of Care • 1-/start of care-further visits planned • 3-Resumption of Care (after inpatient stay) Follow up • 4-Recertification (follow up) reassessment {Go to M0110} • 5-Other follow-up {Go to M0110} Transfer to an Inpatient Facility • 6-Transferred to an inpatient facility-pt not DC from agency {Go to M1040} • 7-Transferred to an inpatient facility-pt DC from agency {Go to M1040} Discharged from Agency-Not to an Inpatient facility • 8-Death at home {Go to M0903} • 9-DC from agency {Go to M1040} Clinical Record Issues

7. M0100 (cont.) Start/resumption of care 1-Start of Care-further visits planned 3-Resumption of care (after inpatient stay) Follow-Up 4-Recertification (follow-up) reassessment [Go to M0110] 5-Other follow-up [Go to M0110] Clinical Record Issues

8. M0100 (cont.) Transfer to Inpatient Facility • 6-Transferred to an inpatient facility-pt not discharged from agency [Go to M1040] • 7-Transferred to an inpatient facility-pt d/c from agency [Go to M1040] Discharge from Agency-Not to an Inpatient Facility 8-Death at home [Go to M0903] 9-Discharged from agency [Go to M1040] Clinical Record Issues

9. M0100 (cont.) • Assessment/data collection time points • Reason why the assessment data are being collected and reported -reason for assessment (RFA) • Data reporting software accepts or rejects certain data based pm the M0100 response -Accuracy critical Clinical Record Issues

10. RFA 1: Start of Care • Must be conducted during a home visit • Comprehensive assessment completed when the POC established -Whether or not further visit will be provided after the SOC visit -Appropriate response anytime a HHRG is required Clinical Record Issues

11. RFA 3: ROC • Must be conducted during a home visit • Resumption of care (ROC) comprehensive assessment • Performed when resuming care of patient -following inpatient stay of 24 hrs. or longer -for reasons other than diagnostic testing Clinical Record Issues

12. RFA 3: ROC (cont.) • If resuming care during last 5 days of the episode following inpatient discharge -Perform ROC not a Recertification (RFA 4) Answer payment questions as if Recert -This assessment establishes payment code for next 60-day episode Clinical Record Issues

13. RFA 4: Recertification • Must be conducted during a home visit • Comprehensive assessment during last 5 days of the 60-day cert period -Need to continue services for additional 60-day episode of care • If HHA misses recert window -Make a visit as soon as possible -Explain in clinical documentation Clinical Record Issues

14. RFA 5: Other Follow-up • Must be conducted during a home visit • Comprehensive assessment due to a major decline or improvement in health status -At any time other than during the last 5 days -HHA should have policy • Reevaluation of patient’s condition -Allowing revision of POC, as appropriate Clinical Record Issues

15. RFA 6: Transfer; No DC • Data collection completed when: -Admitted to inpatient facility bed for 24 hrs or more -For reasons other than diagnostic test • Exception that home care will be resumed following discharge from facility Clinical Record Issues

16. RFA 6: Transfer; No DC (cont.) • Short stay observation periods in a hospital do not count as a transfer -regardless of duration • Not a comprehensive assessment-does not require a home visit -May gather information via telephone • If hospitalization discovered during home visit, need transfer (RFA 6) and ROC Clinical Record Issues

17. RFA 7: Transfer & DC • Data collection completed when: -Admitted to inpatient facility bed for 24 hrs or more -For reasons other than diagnostic test • No plan to resume care of patient • No additional OASIS DC data required • Short stay observation periods in a hospital do not count as a Transfer -Regardless of duration Clinical Record Issues

18. RFA 7: Transfer & DC (cont.) • Also completed when patient dies: -In ER -In inpatient bed before stay of 24 hours (M0906 guidance) Clinical Record Issues

19. RFA 8: Death at Home • Data collection-not assessment • Patient dies before being treated in an ER or before being admitted to an inpatient facility Clinical Record Issues

20. RFA 9: Discharge • Comprehensive assessment when patient discharged from agency -For reasons other than death or transfer to inpatient facility -An actual patient interaction, a visit, is required • Complete when you transfer and discharge to another HHA or an in-home hospice Clinical Record Issues

21. Unplanned or Unexpected Discharge • If discharge is unplanned, requirement must still be met • Discharge assessment must report patient status at an actual visit • Assessment data should be based on the last visit conducted by a qualified clinician Clinical Record Issues

22. M0102 • (M0102) Date of Physician-ordered Start of Care (Resumption of Care): If the physician indicated a specific start of care (resumption of care) date when the patient was referred for home health services, record the date specified. • _ _/_ _/ _ _ _ _ • Month/date/year • {Go to M0110, if date entered} • NA – No specific SOC date ordered by physician Clinical Record Issues

23. M0102 (cont.) • Date of physician-ordered SOC/ROC -If MD indicated a specific date on referral -If date entered, skip M0104 Date of referral and go to M0110 Episode Timing -Mark NA: If initial orders do not specify a SOC date • If the originally ordered SOC is delayed for any reason -Report the date on the updated or revised order Clinical Record Issues

24. M102 (cont.) • Referral from a facility is made on behalf of the physician and is considered for M0102 • Date must be specific, not ranges (i.e., 1-2 days following hospitalization) Clinical Record Issues

25. M0104 • (M0104) Date of Referral: Indicate the date that the written or verbal referral for initiation or resumption of care was received by the HHA. • _ _/_ _/_ _ _ _ • Month/day/year Clinical Record Issues

26. M0104: Date of Referral • Most recent date verbal, written or electronic authorization to begin care was received by HHA • If SOC is delayed for any reason, driven by patient’s condition of MD request • -Report the date HHA received updated/revised referral information • Does not refer to calls from ALF or family preparing HHA for possible admission Clinical Record Issues

27. M0110 • (M0110) Episode Timing: Is the Medicare home health payment episode fro which this assessment will define a case mix group an “early” episode of a “later” episode in the patient’s current sequence of adjacent Medicare home health payment episodes? • 1 -early • 2 -later • UK -unknown • NA -Not applicable: No Medicare case mix group to be defined by this assessment Clinical Record Issues

28. M0110: Episode Timing • PPS payment item -Also used by non-PPS payers using a PPS-like payment model • Identifies placement of the current MC payment episode in the patient’s current sequence of adjacent MC PPS payment episodes Clinical Record Issues

29. M0110: Episode Timing (cont.) • Sequence of adjacent MC PPS payment episodes = a continuous series of MC PPS payment episodes -Regardless of whether the same HHA provided care for the entire series -Low utilization payment adjustment (LUPA) episodes (less than 5 total visits) and Partial Episode Payments (PEP) included -Denied episodes are not included Clinical Record Issues

30. M0110: Episode Timing (cont.) • Adjacent means there was no gap between MC-covered episodes of more than 60 days -care under HMO, MA or private payer = gap days when counting the sequence of MC episodes Clinical Record Issues

31. M0110: Episode timing (cont.) • “1-Early” selected if this is: -The only PPS episode in a single episode case Or -The first or second PPS episode in a sequence of adjacent MC home health PPS payment episodes Clinical Record Issues

32. M0110: Episode Timing (cont.) • “2-Later” selected if this is: -The third or later PPS episode in a current sequence of adjacent Medicare home health PPS payment episodes • “UK – Unknown” selected if: -The placement of this PPA payment episode in the sequence of adjacent episodes is unknown -For payment, this will have the same effect as selecting the “Early” response Clinical Record Issues

33. M0110: Episode Timing (cont.) • Enter “NA” if no Medicare case mix group is to be defined for this episode • If you select “NA” you cannot generate the PPS payment code (HIPPS/HHRG) • Some non-MC payers will use this information in setting an episode payment rate Clinical Record Issues

34. Counting Days Manually • An MC payment episode ordinarily comprises 60 days beginning with SOCdate, or 60 days beginning with recertification date • There can be a gap of up to 60 days between episodes in the same sequence • To determine if adjacent count from the lastday of one payment episode (Day 0) until the first day of the next • If you count 60 or less = adjacent episode Clinical Record Issues

35. Counting Days Manually (cont.) • A sequence of adjacent MC payment episodes continues as long as there is no 60-day gap, even if MC episodes are provided by different home health agencies • Episodes with HMO’s, Medicaid, or private payers do not count as part of a sequence-they are part of the gap between PPS episodes • If the period of service with those payers is 60 days or more, the next MC home health payment episode would begin a new sequence Clinical Record Issues

36. Questions???E-mail: health.oasis@state.mn.us Cindy Skogen, RN; Oasis Education Coordinator 651-201-3818 Clinical Record Issues