OASIS Alert

MA patients excluded from quality measure.

It may look like an episode and pay like an episode, but an MA episode may not count as one.

Question: Many of our patients are enrolled in Medicare Advantage plans. When we assess these patients, do we use the new OASIS forms? And are these patients included in Home Health Compare and outcome based quality improvement data in 2008?

Answer: You complete the OASIS assessment for patients from any Medicare Advantage plan that is going to pay your agency based on the Medicare fee-for-service episode system, explains home care consultant Judy Adams with Charlotte, NC-based LarsonAllen.

Some plans expect to use the current PPS episode system, some are planning to go to the new system and others may decide something else, Adams tells Eli. So you will need to contact each of your Medicare Ad-vantage and HMO plans to see what they will be using in 2008, she recommends.

If the Medicare advantage program is paying on an episode basis, you will need to complete the OASIS version that goes with the reimbursement system elected by the Medicare Advantage plan -- current or new 2008 system.

Data concerns: Patients for whom you answer 1, 2, 3 or 4 on M0150 are included in OBQI and Home Health Compare data, says consultant Lisa Selman-Holman with Denton, TX-base Selman-Holman & Associates

Hidden trap: MA episodes do not count in determining a series of adjacent epi-sodes under M0110 in the new PPS system.