OASIS Alert

But that's the intermediaries' rule -- not CMS's.

Question: We are confused about when to enter updated exacerbation and onset information. Does CMS address whether to enter the information before you import the assessment?

Answer: No, the only place you'll find guidance for onset and exacerbation dates is in your intermediary's manual, says clinical consultant Lisa Selman-Holman, with Denton, TX-based Selman-Holman & Associates.

The Centers for Medicare & Medicaid Services doesn't require that you list diagnoses' onset and exacerbation dates, Selman-Holman points out. "There are many myths as to what should be done to complete those dates," she explains. Originally required by Palmetto, even intermediaries don't provide clear guidance on how to accurately fill in the information.

Flaw: Intermediaries' push for onset and exacerbation dates is misleading, Selman-Holman asserts. "Not every diagnosis magically exacerbates every 60 days in time for recertification," she points out. However, by requiring agencies to fill in that information, intermediaries force them to choose whether a diagnosis is new or an exacerbation of an existing condition.

Your job: Even though onset and exacerbation dates are unclear and may not be clinically precise, you can protect your agency and ensure your patients' health by documenting their conditions as accurately as possible before you import the assessment. This way, your patients' records will be correct -- whether the onset and exacerbation dates are obvious or not.