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Home Health & Hospice Week

Reimbursement:

Increase M0175 Accuracy With These Steps - Before It's Too Late

Published on Mon Aug 04, 2003

If you fail to tighten up your procedures for the newest hot button OASIS item, you could face downcoding, medical review and even fraud and abuse scrutiny.

The HHS Office of Inspector General has a bee in its bonnet over inaccurate answers to M0175 (see story, "Brace for Expanded Medical Review in Wake of M0175 Probe"). And if you're not careful, the probe could swarm your home health agency.

The OIG insists it's up to HHAs to ferret out the correct hospital discharge information for M0175. "Clinicians should make every reasonable attempt to obtain and report accurate data on the type of facilities and the dates of beneficiary discharge within the 14 days preceding the HHA episode," the OIG says in its report on M0175.

In the more than 200 OASIS accuracy audits consulting firm BKD has completed for its clients, almost 9 percent of assessments turn up with "variations" in the service domain, consultant Karen Vance in Springfield, MO tells Eli. Of those errors, 74 percent occur because of inaccurate M0175 responses, she says.

Vance recommends HHAs take these steps to increase M0175 accuracy:

  • Focus on intake. Agencies can eliminate many M0175 errors by making sure the intake department gathers the correct discharge information up front. Make discharge information a priority and be sure to have intake staff ask referral sources pointed questions about it.

  • Compare length of stay. Intake staff should determine the patient's diagnosis related group for the hospital stay. Then you should compare the patient's LOS against a list of average stays per DRG. If your patient's stay is significantly longer than average, that's a signal to go back and ask questions about discharge.

  • Ask a few simple questions. Whenever a patient is discharged from the hospital, a few quick questions from the clinician completing the OASIS assessment may head off M0175 trouble. Simply asking "did you move beds while you were in the hospital" or "did you move floors" can show you whether to research the patient's discharge further.

    "You can do these quickly with little effort," but with a big impact on your billing and OASIS accuracy, Vance says.

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