OASIS Alert

Published on Thu Apr 24, 2008 PDF

Capture the case mix points you deserve using these 7 expert tips.

When was the last time you trained staff on assessing activities of daily living or understanding skip patterns?

Diagnosis coding questions may be getting all the press, but the other OASIS M0 items are equally important in achieving success under the 2008 home health prospective payment system. So while you train your staff on the details of episode timing for M0110 or the new therapy rules for M0826, refresh their memories about the ABCs of OASIS assessment.

OASIS is a standardized data set and to keep it standardized, agencies need to follow official guidelines from the Centers for Med-icare & Medicaid Services, says clinical consultant Judy Adams with Charlotte, NC-based LarsonAllen. CMS is continually updating and clarifying these, so you need to keep up with official statements and questions and answers, she said.

Adams focused on these seven rules as part of her recent Eli-sponsored audioconference Case Mix for Accurate PPS reimbursement - Part 1:

1. Complete each OASIS assessment independently without referencing any prior assessments.

2. Use the response N/A (not applicable) only when no other response is possible.

3. Concentrate on direct observation rather than interviewing. "Interviewing will get you some information, but it really won't get you accurate scoring in OASIS," Adams warned.

4. Know which questions require you to mark all the answers that apply.

5. Understand the assessment timeframe. Unless the question directs otherwise, look at the 24 hours preceding the assessment and include the assessment visit itself, Adams said.

6. Recognize that "most of the time" means greater than 50 percent of the time. And when assessing multiple tasks within the same item (such as for ADL items) see if the patient can do more than 50 percent of the tasks.

7. Pay attention to skip patterns to save time in completing the assessment.

Besides following the CMS rules, there are specific techniques that will help you capture the allowed case mix points for each episode, Adams explained.

Smart idea: The most important technique is to read the responses from bottom to top to select the most accurate score for each item, Adams said. Reading from the bottom shows you the most impaired responses first. "Time and again, agencies that follow just this one tip improve case mix scores and better capture the acuity of patients," Adams reported.

Watch out: Score the patient without considering changes in abilities that result from interventions you provide during the assessment visit, Adams said. On the initial assessment you want to capture the baseline, not how the patient is after you provide teaching or adaptive equipment, for example.

Other tips and techniques Adams shared include:

• Score for safety. Even if the patient lives alone, score based on whether the patient can complete the required task safely.

• Avoid assumptions. For each M0 item, be sure you understand what the item is asking, what is included and what time frame to use.

• Collaborate. To determine the most accurate responses, collaborate with other disciplines, Adams recommended.