OASIS Alert

Published on Fri May 13, 2005 PDF

Use C0F0S0 to screen for OASIS errors.

You might wonder why a patient with no clinical, functional or service points from the OASIS assessment needs home care - or at least Cahaba GBA thinks you should wonder.

Caution: Cahaba is initiating a new universal edit for home health claims billed with HIPPS code HAEJ1, the regional home health intermediary announced April 28. This lowest paying code "indicates patients with a low clinical severity that are also highly functional," Cahaba says. A 100-claim probe edit indicated frequent denials for HAEJ1 patients as "not homebound," Cahaba says.

Reason: These HAEJ1 claims translate to the C0F0S0 home health resource group. A functional domain of "0" (F0) means you indicated on M0700 that the patient is able to walk independently on even and uneven surfaces and climb stairs, even without railings, says Ft. Myers, FL-based consultant Sparkle Sparks. Further, you've indicated that the patient can do so without an assistive device or any human assistance, she adds.

This high level of functioning brings the patient's homebound status into question. The most likely scenario where a C0F0S0 patient might still be homebound would be a psychiatric problem, Sparks says.

There are situations when the patient could score C0 and still have a clinical need, Sparks explains. For example, you could have one clinical need - either impaired vision (M0390), pain interfering with activity (M0420), dyspnea with exertion (M0490), urinary incontinence (M0530) or a behavior problem (M0610) - and still have a C0 score, she says. 
 
What to do: First, ask if the clinician made an error in scoring the OASIS, Sparks suggests. Most audits of this category will show a scoring error, she predicts. You have to be aware that you are "skating on thin ice" regarding homebound status when you have no functional deficit, she adds.

Another possible reason for a C0F0S0 result is that the clinician entered information inaccurately, says Rose Kimball of Dallas, TX-based Med-Care Administrative Services. Double-checking this HHRG helps you detect this kind of OASIS error, she notes.

If you find errors, use the opportunity to teach your staff - or the clinician, if the mistakes are consistently one person's - how to do the assessment correctly.
 
Bottom line: Think carefully before you admit a patient who really has a C0F0S0 score, says consultant Melinda Gaboury of Nashville, TN-based Healthcare Provider Solutions. This score says "they have no clinical needs, no functional needs, haven't been discharged from a rehab facility and don't require therapy," she says. If the assessment is accurate, you need to be very careful to justify and document both the patient's homebound status and the need for skilled care, experts agree.