Home Health Coding and OASIS Expert

Are you 100 percent confidently wrong?

Even good clinicians can fall victim to poor data collection practices. If you don’t take time to tune-up your OASIS completion practices every so often, your responses won’t paint a true picture of your patient. Whether you under-score

or over-score — an inaccurate OASIS assessment can mean payment and outcome problems.

Watch Out for Repetition

The OASIS is a complex document, says Pat Jump with Rice Lake, Wis.-based Acorn’s End Training & Consulting. “It is important for all clinicians to base assessment decisions on actual instructions rather than on assumptions or an individual’s interpretation of how to accurately complete an OASIS assessment.”

Unfortunately, “clinicians can start to get stuck in patterns,” when answering the OASIS, says Beth Johnson, MBA, BSN, RN, CRRN, HCS-D, HCS-O, President of Johnson, Richards & Associates, in Brighton, Mich. “You’re tired after working an entire day and productivity standards are high.”

For example: Perhaps you once heard that anyone on narcotics or benzodiazepines should be marked as having a recent change in behavior for M1032, Johnson proposes. “There’s nothing in the Q&As to support this. Someone probably told them this once, the clinician runs with it and then they begin to misinterpret all of the cognitive questions, based on someone having a pain medication prescription.”

Although the use of narcotics or benzodiazepines may result in a change in behavior, that doesn’t necessarily mean there has been a change in behavior, or that a change in behavior is resulting in an increase in the risk for hospitalization (the intent of the item), says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, HCS-O, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas. Be careful of “guidance” that provides a pat answer and remember the OASIS is an assessment based on official guidance.

Try this: As QA staff reviews completed OASIS assessments, watch for patterns in each clinician’s documents. This may be a sign that there’s a need for training.

Know Where to Look for Answers 

It’s not uncommon to hear clinicians offering up OASIS advice they once heard in a seminar or read on a message board, but you should always check these tips against official sources.

“Over the years I have conducted OASIS training, I have heard many inaccurate statements from clinicians,” Jump says. “Sometimes the clinician is certain about the erroneous statement because, ‘we have always done it this way.’ Some have even stated that they are sure they have the correct information or ‘someone in our agency would have made us change it.’”

Sometimes, a fellow clinician, consultant, or trainer can be very adamant about a very “wrong” answer, Jump says. “One person once said to me about another person, ‘She was 100 percent confidently wrong.’ Having confidence is not the same as being correct.”

So how do you know where to look for the correct information related to OASIS assessment? Don’t simply accept an answer regarding OASIS assessment accuracy, Jump cautions. Always determine the source of the answer. The sources for reliable OASIS assessment accuracy include the following, she says:

• Current Centers for Medicare & Medicaid Services OASIS guidance manual: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIOASISUserManual.html
• CMS OASIS website: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/OASIS/index.html
• CMS Webinars: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/OASIS/Training.html
• CMS Quarterly Questions & Answers: https://www.qtso.com/hhatrain.html
• Reliable OASIS trainers

Helpful: The quarterly OASIS Q&As are especially useful since they address actual home care scenarios and provide answers from CMS, Jump says.

Caution: Always verify any OASIS clarifications you get from discussion groups, blogs, or listservs against the sources listed above. 

Regular OASIS training sessions conducted by a qualified trainer can help correct and clarify misconceptions, Jump says. Be sure to include time for discussion. Providing weekly OASIS assessment tips to each clinician can also help provide ongoing clarification, she says.