Do your clinicians understand what one wrong answer can do to your agency's bottom line?
The points awarded for answers to certain OASIS questions add up to a clinical, functional and resource utilization severity score, represented by CxFxSx in the Home Health Resource Group (see OASIS Alert Vol. 4, No. 11, pp. 102-103). Each of these case mix combinations is assigned a case mix adjustment value. Multiplying this value by the standardized payment rate gives you the reimbursement rate for an episode for any patient with this case mix combination.
The chart below, from Jim Robinson, senior financial analyst with Rohnert Park, CA-based Boyd & Nicholas, demonstrates just how valuable OASIS accuracy can be.
An episode reimbursement for a patient with a score of C0F0S0 (clinical, functional and resource utilization levels all minimum) would be $1,174.44, while C1F0S0 would be $1,387.69. So if a clinician answers M0540 wrong, perhaps not knowing a patient has bowel incontinence more often than once a week - which adds 9 points to the clinical score and bumps the HHRG from C0 to C1 - this costs your agency over $200 in reimbursement. (These amounts are unadjusted for the local wage index.)
