Home Health & Hospice Week

Beware of using an incorrect episode start date.

Question: My home health agency admitted a patient for physical therapy only and sent a nurse out who did the start of care OASIS. Before the PT could get in to do his evaluation, the patient fell and went into the hospital. After 10 days the hospital discharged the patient to home, and a nurse went back in to do the resumption of care; the PT went in and did his evaluation, and everything proceeded normally. I realize I can't bill for that initial nursing visit, but what should I put on my plan of care and claim for episode start date?

--Florida Subscriber

Answer: If the agency had sent in a therapist to do the initial assessment, the episode would begin on the date of the original assessment visit. But "in the situation you describe ... the Start of Care Date and beginning of the episode would actually have to be the date the nurse did the ROC date," explains consultant Judy Adams with LarsonAllen based in Charlotte, NC. That's because "no skilled service was ever provided to establish a start of care date until PT visited after the ROC."

The good news: The SOC and ROC assessments include all of the same data, which is fortunate for the agency, Adams tells Eli. "But the ROC reason for assessment would need to be change to be a SOC, and that would also correspond to the beginning of the episode," she instructs.

Note: Please submit your reader questions on any home care topic to editor Rebecca Johnson at rebeccaj@eliresearch.com.