OASIS Alert

Published on Thu Feb 28, 2013 PDF

 Don’t miss the difference between payment episode and care episode.

Three questions will help you determine how to answer M1040 -- Did the patient receive the influenza vaccine from your agency for this year’s influenza season (October 1 through March 31) during this episode of care? Make certain you know how to answer them and you’ll boost your accuracy for this publicly reported process measure item.

Establish the Basics

OASIS item M1340 is one of the items often answered incorrectly despite the years of previous instructions and clarifications, says Pam Warmack, RN, BC, CHCE, HCS-D, COS-C, with Clinic Connections in Ruston, La. This item asks you to indicate whether you provided a vaccine for the current year’s flu season during the current episode of care.

Your response options for M1320 are:

0 -- No;

1 -- Yes; or

NA -- Does not apply because entire episode of care (SOC/ROC to Transfer/Discharge) is outside the influenza season.

Complete M1040 at transfer, and discharge not to an inpatient facility.

To make certain you’re answering this item correctly, ask yourself three questions, Warmack says.

Question 1: What is the quality care episode which the transfer/discharge is addressing?

One common error with M1040 is the misapplication of a billing/reimbursement episode of care rather than a quality episode of care, Warmack says. "Frequently, clinicians will answer "0 -- No" if the patient did not receive a flu vaccination during the 60 day episode of care during which the transfer or discharge OASIS occurred," Warmack says.

But it’s the quality care episode that applies to this question, Warmack explains. To determine which date range you should consider when answering M1040, go back to the most recent SOC or ROC and carry through to the transfer or discharge to determine which episode of care (or quality episode) is in question.

Question 2: Did a flu season occur within the care episode?

The October 1 through March 31 time period specified in M1040 isn’t meant to indicate the flu season. Instead, this is the date range for which the Centers for Medicare & Medicaid Services will calculate the flu vaccine process measure.

The current flu season is established each year by the Centers for Disease Control (CDC). And flu vaccine manufacturers release the vaccine following the CDC recommendations, CMS said in a January 2013 OASIS Q&A.

So, your signal for tracking the beginning of the current flu season is to note when the flu vaccine is available for administration -- usually in late summer or early fall. The end of the flu season is generally considered March 31st CMS said.

However, if your agency gives a patient the flu vaccine after the typical end of flu season (March 31st), you could still answer M1040 "1 -- Yes" as long as at least one day of the quality episode fell between October 1st of the prior year and March 31st, CMS explained.

But if no day in quality episode falls between October 1 and March 31, "NA" is the appropriate M1040 response, even if you gave the patient the influenza for the current flu season.

Question 3: If a flu season did occur within the care episode, did the patient receive a flu vaccination from a clinician employed with the home care provider?

In order to answer "1 -- Yes" for M1040, your agency must have administered the flu vaccine.

A common mistake with this item is to answer yes or no based on whether or not the patient received a flu vaccine from anyone, Warmack says. But the question is asking if someone from your home care agency administered the vaccine.