OASIS Alert

A: This question involves one of the more confusing areas of home care, reports Chapel Hill, NC-based clinical consultant Judy Adams with LarsonAllen Health Care. Ordinarily the home health agency does a follow-up assessment within the last five days of an episode to determine the Home Health Resource Group/HIPPS code for the next episode. And a transfer and resumption of care would work if the patient is hospitalized at the end of the episode, but returns home on or before day 60 of the episode.

Problems arise when the patient remains in the inpatient facility on the first day of the new 60-day episode, leaving a gap between episodes, Adams explains. In this case, the patient must be discharged, and the agency must complete a new start of care OASIS when the patient returns to home care. "The Centers for Medicare & Medicaid Services will not allow an agency to certify a patient (develop a new plan of care/485) for home health when the patient is an inpatient in a facility," she instructs.

It's especially frustrating when the clinician has completed the recertification OASIS assessment within the five-day window and then can't use it because of the timing of the patient's hospitalization, Adams acknowledges.