Home Health & Hospice Week

OASIS:

Play Detective In Patients' Homes To Crack M0175 Case

Published on Thu Sep 09, 2004

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.

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.

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.

Try these crucial queries:

"Did you stay in the same room the whole time? What floor were you on? Did you move to a different floor?" Most HHAs employ nurses who once worked in area hospitals. It should be relatively simple for an agency to compile a list of what hospital floors contain what kind of beds - acute care, rehab, etc. "Commit that information to paper and make sure that everybody in your agency knows that," Vance instructed. Then clinicians can check their patients' information against that master list.

"Did they make you get dressed or eat your meals in a different room?" Rehab units typically require patients to get out of bed, get dressed and eat in a common room, Vance noted. So if the patient took part in those activities, it's a clue that should spur you to confirm the rehab stay.

"Did you get a lot of therapy?" High therapy utilization is another clue that a rehab stay occurred, Vance added.

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:

Discharge instructions. Are there discharge instructions laying around from a facility that wasn't listed on the patient's referral? If so, you'd better investigate, Vance advised.

Equipment labels. Is there equipment in the home with an "XYZ Rehab Unit" tag on it? "It may have been there for 17 years, but at least ask the question," Vance said.

Exercise program. Check for a facility's name on any home exercise program the patient possesses.

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.