OASIS Alert

Published on Mon Mar 24, 2008 PDF

More OASIS Q&As due out in April.

Now you'll see why the question for M0826 is so long and convoluted.

Clinicians have been asking the Centers for Medicare & Medicaid Services how they should answer M0826 on resumption of care assessments. Should they mark the same number of therapy visits that were on the start of care assessment or should they mark the number of therapy visits they think are left? Neither one, CMS says in a Feb. 27 email to Home Health, Hospice and DME Open Door Forum participants.

The question: M0826 asks, "In the plan of care for the Medicare payment episode for which this assessment will define a case mix group, what is the indicated need for therapy visits (total of reasonable and necessary physical, occupational, and speech-pathology visits combined)?"

Don't miss: The crucial words are "for which this assessment will define a case mix group," CMS explains. Most of the time, the data from the resumption of care OASIS assessment is not used for prospective payment system payment determination (a case mix group). In these situations, use M0826 response NA (Not Applicable: No case mix group defined by this assessment), CMS instructs.

Exception: In some cases, the ROC assessment also acts as the recertification assessment, CMS reminds providers. This happens when a patient under an active home health plan of care is discharged from an inpatient facility back to the agency in the last five days of the certification period. In this situation, CMS allows the provider to use the ROC assessment as the recertification assessment as well. And in a recert assessment, clinicians must answer M0826 to determine payment for the upcoming 60-day episode, CMS notes.

What to do: When a ROC assessment is used as a recert, then the data is used to define a case mix group, and clinicians must report in M0826 the number of therapy visits planned for the next episode, CMS says.

For a detailed OASIS question and an-swer on this topic, CMS refers providers to the April 2008 release of updated Q&As on the OASIS Certificate and Competency Board's Web site (www.oasiscertificate.org).