OASIS Alert

Do you know which RFA to complete when a patient dies in the ER?

When a patient is transferred to the inpatient facility for a stay of 24 hours or longer, you’ll need to decide whether it’s appropriate to complete an RFA6 or an RFA7. Do you know when to complete each type of transfer?

The key is to determine whether you expect the patient to return to service. If you plan on the patient returning after an inpatient stay, complete the RFA6 (Transfer to an inpatient facility patient not discharged from agency). If you don’t expect the patient to return to home care, you’ll complete an RFA7 (Transfer to an inpatient facility patient discharged from agency).

Complete an RFA7 when your patient needs a higher level of care and is no longer appropriate for home health care, when the patient’s family plans to move him out of the service area, or when the patient is no longer appropriate for the home health benefit.

Guidelines: You must complete the RFA6 or RFA7 within two calendar days of the date your patient transfers to an inpatient facility, or within two days of knowledge of the qualifying transfer.

Remember: The patient must be transferred and admitted to an inpatient bed in an inpatient facility for a stay of at least 24 hours. The transfer cannot be to an outpatient facility or to an Emergency Room. The reason for the patient’s admission must be something other than diagnostic tests.

Now that you know the basics of when each type of transfer is appropriate, see if you can select the right one to use in the following scenarios.

Scenario 1: Patient receives care in the ER but dies after he has been transferred for observation under one of the outpatient observation service G codes.

Answer1: Complete an RFA7 for this patient, the Centers for Medicare & Medicaid Services advises in the OASIS Q&As.

Scenario 2: Your patient receives skilled nursing care from your agency under Medicare, but every so often he stays in the hospital under a private pay arrangement to give his family respite.

Answer 2: You will need to complete a transfer OASIS for this patient, but which one depends upon whether you expect him to return to your agency. Respite care is more than diagnostic testing, CMS says, and when a patient is admitted to an inpatient facility bed for 24 hours or longer for reasons other than diagnostic testing you’ll need to complete a transfer OASIS. Complete an RFA6 if you expect him to return or an RFA7 if you don’t expect his return.

Scenario 3: Patient dies during outpatient surgery.

Answer 3: Complete an RFA7 for this patient, CMS says.

Scenario 4: You completed an RFA6, but the patient did not return to your agency. Do you need to cancel the RFA6 and complete an RFA7?

Answer 4: No. No further OASIS is required in this situation. The quality episode ends with the RFA6, CMS says. Just be sure to complete your agency’s internal discharge paperwork. “The patient will remain on your OASIS Patient Management Roster for 6 months; after which time the patient name is dropped from the Data Management System (DMS) report,” CMS says.

Tip: You’ll need to contact the facility to verify the type of care that the patient is receiving in order to select an accurate response M2410 — To which Inpatient Facility has the patient been admitted? Choose response “1 — Hospital” if the patient is using a hospital bed. Report response “3 — Nursing home” if the patient is using a nursing home bed.

Scenario 5: Patient dies in the ER or within 24 hours of being admitted to an inpatient facility.

Answer 5: Complete an RFA7 for this patient.

Note: Read all the current OASIS Q&As here: www.oasisanswers.com/aboutoas_links.htm.