OASIS Alert

Published on Sun Nov 27, 2011 PDF

Do you know how much your M1200 inaccuracies are costing you? It could be more than $600 per episode.

M1200 responses "1" or "2" provide one case mix point in equations 1 and 4, and one point is all it takes sometimes to change the clinical dimension from C1 to C2 or C2 to C3, says Kristi R. Wheeler, RN, HCS-D, COS-C owner of ACCS (Agency Compliance & Consulting Service) in Terrell, Texas.

In Equation 1, the change from a C1 to a C2 results in an approximately $300 increase in episode payment, and a change from C2 to C3 results in an approximate $335.00 increase in episode payment, Wheeler says.

In equation 4, the change from C1 to C2 results in an approximate $548.00 increase in episode payment, while a change from C2 to C3 results in an approximate $639.00 increase in episode payment, Wheeler points out.

"Some agencies may not view this as a high priority item since it is awarded 'only' one point and only in equations 1 and 4," Wheeler says. "But this one point can greatly impact reimbursement if it is the one point that changes the clinical dimension score."

Caution: There is great potential for upcoding of this item, Wheeler warns. "If the one point does result in a higher clinical score, and it is determined this item was not scored correctly, there is potential for the agency to have recoupment of funds due to the improper HHPPS code being reported on the claim." To avoid this, make certain to document the interventions you will provide to compensate for your patient's vision deficit.