OASIS:
BEAT M0175 CONFUSION WITH THESE 6 TIPS
Published on Mon Mar 13, 2006
Know your nursing home categories.
If you're miscoding the highly scrutinized OASIS item on prior inpatient stays, it's like waving a red flag in front of your intermediary's medical reviewers.
The Centers for Medicare & Medicaid Services says it will have intermediaries crack down on home health agencies that are submitting a high number of claims that code M0175 incorrectly, according to a recent HHS Office of Inspector General report on the issue (see Eli's HCW, Vol. XV, No. 14).
Watch out: That means you may become a medical review target if your rate of adjustments for the OASIS item is high, warns consultant M. Aaron Little with BKD in Springfield, MO.
How it works: Upcoding M0175 can bring an agency an extra $600 per episode for a patient who reaches the 10-visit therapy threshold or an extra $200 for a non-therapy patient. The increase occurs when the agency marks that the patient had a rehab or skilled nursing facility discharge (response 2 or 3) without also marking a hospital stay (response 1) for the 14 days prior to admission.
Here are six tips to keep you off the intermediaries' radar screen for M0175 mistakes: • Grill nursing facilities. Many clinicians still fail to understand the difference between a "skilled nursing facility" (response 3) and an "other nursing home" (response 4). You should mark SNF if the patient received skilled care under Medicare Part A while in the nursing home during the 14-day timeframe before admission, CMS says in the response-specific instructions in the OASIS User's Manual. When you mark "other nursing home," payment isn't increased.
Do this: When you receive a nursing home referral, ask whether the patient received Medicare Part A benefits during any part of her stay, Little advises. "If the answer is 'yes,' the patient was in a SNF." Then find out exact dates to see if they fall in the 14-day window. • Make a referral source cheat sheet. It can be very difficult to discern which referral sources actually encompass which type of facilities under M0175. "Compile a list of referral sources and indicate which sources have a SNF or rehab unit, including the specific room numbers, floors, wings, etc. in which the units are located," Little recommends. Remember to include hospitals, because they may have a distinct skilled nursing or swing-bed unit that qualifies as a SNF.
"Distribute the list to the clinicians," Little says. That way staff have a resource to help guide their questions to referral sources, discharge planners, pa-tients and family members. • Examine hospital stays. Don't just assume a hospital stay results in marking response 1. "If the patient was in the hospital setting for an extended period of time and received a high amount of [...]
