Examine the revamp of pressure ulcer, transfer items before changes hit in a year. The new OASIS-C form won't just change patient data collection -- it could change your Medicare payments, too. In the new OASIS-C form, the Centers for Medicare & Medicaid Services overhauls its questions on pressure ulcers. That's likely to be the OASIS-C change with the biggest dollar impact, estimate Judy Adams, consultant with LarsonAllen based in Charlotte, N.C., and Ann Rambusch with Ram-busch3 Consulting in Round Rock, Texas. CMS and its OASIS contractors have added a number of process-based M0 items on pressure ulcer risk assessment and interventions (see related story, p. 330). But the new pressure ulcer matrix in M1310 and rewording in other pressure ulcer questions will change reimbursement for pressure ulcers the most, experts believe. For example: The matrix includes a stage description for deep tissue injury, Adams points out. And the questions differentiate between healed and other ulcers, Rambusch notes. Home health agencies won't know the exact effect on reimbursement until CMS issues new case mix scoring to go along with the new OASIS tool, Adams says. Final changes to the form, due out next year, and item-by-item instructions could also affect the ultimate reimbursement impact of OASIS-C. CMS could also decide to link payment to the new process-based questions, including those on pressure ulcers, Adams adds. Transferring change: Another big-ticket OASIS change could be the revamp of the items on toileting, bathing, and transferring, Adams and Rambusch predict. CMS has split the current M0680 into two items, M1840 (Toilet Transferring) and M1845 (Toileting Hygiene). And CMS has moved the toileting element completely out of M0690 (Transferring), instead focusing on just bed and chair transferring. A change to the item on bathing (M0670), which includes a transfer element, could also spell a dollar difference, Rambusch says. The new item (M1830) would include "getting in and out of the tub/shower" in answer #1 and splits answer #4 into two responses. Note: See the new OASIS-C form and its supporting documents (including a crosswalk from OASIS-B1 to proposed OASIS-C M0 items) at
http://www.cms.hhs.gov/PaperworkReductionActof1995/PRAL/list.aspsearch for CMS-R-245. Or e-mail editor Rebecca Johnson at
rebeccaj@eliresearch.com with "OASIS-C November" in the subject line for a free PDF copy.
