Home Health Coding and OASIS Expert

Are you making this ‘dumb question’ mistake?

Whether you’re completing the OASIS or selecting diagnosis codes, it’s impossible to have all of the answers all of the time. It’s OK to have questions — even when the pressure’s on to move through your work quickly. Try these expert tips to help boost your accuracy and your peace of mind.

Find Answers Like the Experts

“I have been teaching OASIS since its inception, and I still do not know all the answers,” says Pat Jump with Rice Lake, Wis.-based Acorn’s End Training & Consulting. “But, guess what? I don’t have to know all the answers to successfully and accurately know how to complete the OASIS data set. I simply need to know where to go to get the answers. I need to know trusted, accurate, reliable resources.” (Note: See the sidebar on pg. 53 for a list of reliable resources.)

“OASIS is complex and evolving. Seeking ongoing clarification of various aspects of OASIS is the only way to even remotely get a handle on the complexity,” Jump says. “And the best way to obtain clarification is to ask questions — lots of questions.”

Managers: Create a Question-Friendly Culture 

“We often hear from home health agency staff that asking questions doesn’t get them anywhere,” says Beth Johnson, MBA, BSN, RN, CRRN, HCS-D, HCS-O, President of Johnson, Richards & Associates, in Brighton, Mich.

To help combat this feeling of helplessness, supervisors, managers, and educators should make sure that when a clinician has a question, he or she is assisted and not judged, says Jump.  “Even if you have previously provided that answer on numerous occasions, questions should be encouraged,” she says.

Managers should keep in mind that adult learners need to hear things (on average) at least 7 times before they remember them, Jump says. But don’t be afraid to simply give the employee some good resources and let her find the answer and then get back to you with what she found. “That way she acquires the answer but also discovers where to find the answers — the reliable resources.”

And make sure resources such as policies and procedures, textbooks, accreditation standards, and regulations aren’t locked away in an educator’s office or someplace else where staff can’t readily access them, Johnson cautions.

Advocate for Answers

Feeling alone with your questions is no picnic, but your agency may have staff available to help. Don’t be afraid to let your educator or quality departments know about your learning needs for specific diagnoses or disorders, Johnson says. “Chances are if you have questions about a particular disease process at least some of your peers do as well.”

And don’t just look for help in the old familiar spots. Seek opportunities to interact with other disciplines, Johnson suggests. “Physical therapists may be able to provide a wealth of knowledge about bone or joint disorders, for instance, while occupational therapists, speech-language pathologists, and social workers may possess specialized knowledge about managing cognitive disorders,” she says.

You may also need to look outside your organization for help. Consider asking your manager about funding for textbooks, smart-phone apps, and other resources that can help staff maintain their current knowledge, Johnson suggests.

Seek out mentors where you work, as well as in different specialty areas outside of home health, Johnson says. “We’ve seen many organizations benefit from inviting a respiratory therapist from the local hospital to present information about pulmonary disorders, oxygen safety, or how to interpret blood gasses.”

Don’t overlook: If you’ve earned a specialty certification, make sure you take advantage of the resources available through the certifying board or body, including publications, continuing education offerings, and chapter meetings, Johnson reminds. “Cultivate a mind-set that learning is a continuous life-long process.” 

Resolve to Ask Questions and Find Answers

“Someone once said, ‘The only dumb question is the one left unasked,’ Jump says. “Another person declares, ‘If you ask a question it makes you look stupid for 5 minutes — but if you don’t ask, you stay stupid for fifty years, so always ask questions in your life.’ I agree, especially as it pertains to OASIS.” 

When seeking answers related to OASIS, keep the following points from Jump and Johnson in mind:

• If in doubt, seek clarification … always, always, always

• Be very careful about where you look for answers — use experienced OASIS trainers and go to reliable resources. Too many organizations “make up” guidance. The Centers for Medicare & Medicaid Services provides the only official guidance.

• Jot down both your question and the answer and keep it in your notes for future reference.

• Never “guess” at an OASIS answer or interpretation of the OASIS item. There is much to lose by guessing, including compromising the quality of care to the client, chancing lower than necessary reimbursement from Medicare, and risking fraud accusations.

• If there is no guidance on a point, Medicare invites you to use the guidance to come to a conclusion on that point. Follow-up by asking Medicare the question through the CMS OASIS Q&A Mailbox (find the address in the resource list on page 53). 

• Be careful when responding to accreditation or state surveyors. Responding with “I don’t know ...” without adding “... but I can find someone for you who does …” is bound to invite a citation.