OASIS Alert

Published on Fri Jan 13, 2006 PDF

Question: I audit and code all OASIS assessments at a home health agency. I was informed that the answer to the M0825 therapy question is based on the number of visits. If the therapist states he/she will be doing 10 or more visits, the answer to the question would be "Yes." If the number of visits turns out to be less than 10, the answer would be "No." This has led to unlocking the OASIS assessments close to the end of the cert period, when we find the therapist will not be meeting 10 or more visits. Is this correct?

Answer: You should answer M0825 based on the orders for therapy and the therapist's best estimate of the number of visits needed to accomplish that goal, explains senior consultant Judy Adams with Charlotte, NC-based LarsonAllen Health Care Group.
You do not need to go back and change the answer to M0825 from "Yes" to "No" if you make fewer than 10 visits in an episode. Your regional home health intermediary has an edit that automatically downcodes claims where M0825 was "Yes" on the request for anticipated payment, but the final claim shows fewer than 10 visits.

But if you originally answered M0825 "No" because you didn't anticipate 10 therapy visits and later find that you made 10 or more visits, you need to take action. Your RHHI will not correct the error in your favor. You must go back, cancel the RAP, and submit a new one with M0825 answered correctly, explains consultant Karen Vance with BKD in Springfield, MO.

Caution: If the increased therapy resulted from an unanticipated change in the patient's condition, you may need to evaluate whether to file a significant change in condition. But be careful to file SCICs only when required or financially advantageous, experts warn (see OASIS Alert, Vol. 6, No. 8).