The right answer to the OASIS question on prior inpatient stays can mean $600 per patient. You can boost the accuracy of your M0175 answers by training your clinicians to put on their Sherlock Holmes hats when first visiting patients in their homes. Ask Patients Questions Patients may not always be the most reliable sources of information, Vance admitted in the teleconference, "M0175: Get It Right the First Time." But there are important questions you can ask patients that will be clues as to whether you need to dig deeper for information on prior inpatient stays.
Observe Carefully If your staff are paying attention, they can pick up all kinds of clues in the home indicating prior inpatient stays you may not be aware of. Keep a sharp eye out for these common items:
Why it matters: Correctly answering the OASIS question on prior inpatient stays can mean a difference of up to $250 for non-therapy patients and up to $600 for patients who break the 10-visit therapy threshold.
The combination of no hospital stay with a rehab or skilled nursing facility stay in the 14 days prior to admission will increase your prospective payment system reimbursement level. And if you claim that upgrade when there really was a hospital stay you didn't know about, everyone from the HHS Office of Inspector General to the regional home health intermediary could be highly skeptical of your innocence.
Visiting clinicians filling out the start of care OASIS assessment should go beyond the initial question on M0175 and really dig down for an accurate answer, urged consultant Karen Vance at a recent teleconference sponsored by Eli Research and The Coding Institute. "Remind your clinicians to probe for as much information as they can in the home," said Vance, with BKD in Springfield, MO.
Increasing M0175 accuracy could be elementary if your staff employ the following strategies for ferreting out prior inpatient stay information in the home.
Try these crucial queries:
With OASIS assessments taking so much time already, can agencies afford to spend this extra time on M0175? "All of these things are not intended to make that admission visit longer," Vance assured. "You're there, you're seeing these things anyway."
And with the OASIS item becoming a reimbursement and compliance hot spot, HHAs can ill afford to give short shrift to the topic. "Heighten your awareness," Vance urged. "Most of these things that we're suggesting should not take additional time."
Editor's Note: To order a recording or transcript of the teleconference, go to http://codinginstitute.com/conference/tapes.cgi?detail=627 or call 1-800-874-9180.