OASIS Alert

Published on Fri Nov 28, 2008 PDF

Maximize your OASIS accuracy with individual training.

Don't wait until the new PPS rule takes effect to get started on your OASIS training, or you'll be losing money while you train.

A close look at the 2008 prospective payment system shows that OASIS accuracy must be your highest priority. And targeted training based on clinicians' individual needs will pay off fastest, experts say.

Clinical and functional M0 items, expected therapy (M0826) and diagnosis codes (M0230, M0240 and M0246) will affect reimbursement in very different ways in 2008. Also whether an episode is early or later (M0110) will be an important new OASIS item to teach clinicians about (see Eli's OASIS Alert, Vol. 8, No. 9, p. 84). Experts provide these tips as you start your preparations:

• Set up a system to answer M0110 accurately. This should start with intake and office staff, rather than relying on clinicians to ask patients and family, experts say. Good communication will be crucial. Involve clerical and billing staff and clinical staff, says William Dombi, vice president for law with the National Association for Home Care & Hospice.

Home health agencies will also need a system to recheck their M0110 information at the time of billing to be able to adjust their expectations for revenue due to late information, adds clinical consultant Judy Adams with Charlotte, NC-based LarsonAllen.

• Update clinicians on therapy changes. They must understand that therapy payment no longer kicks in at 10 visits. And because the new PPS payments closely track therapy expenses, clinicians should be more comfortable allocating therapy based on patient need, says Jeff Lewis, CEO of Baton Rouge, LA-based Lewis Inc.

• Keep the spotlight on M0230 and M0240. Diagnosis coding knowledge and skills will be even more important under the new PPS reimbursement, experts agree. Agencies "need to work out how they are going to fine tune their selection and sequencing of diagnoses," says Chicago, IL-based regulatory consultant Re-becca Friedman Zuber. Starting Jan. 1, PPS will count diagnoses in all six places in M0230/M0240 toward case mix.

Also train staff on the coding and M0 item combinations the new system includes, says consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville.

• Train clinicians with question-focused methods. Once you have trained nurses and therapists on new material, use your data to determine which clinicians are having difficulty with which OASIS items. Then train a clinician only on the items she needs help with, experts suggest. Keep checking for backsliding and retrain as necessary. "This is the surest way to maximize your payment," Lewis says.

• Put new information front and center. Make posters to keep on the wall listing the payment diagnosis codes and the OASIS payment items, Lewis suggests. This will help clinicians understand that these challenges are manageable and provide opportunities to refer to the posters when discussing coding and OASIS answers for specific patients, he says.