OASIS Alert

Scenario #1: On the start of care OASIS, you answered M0110 ("Episode Timing: Is the Medicare home health payment episode for which this assessment will define a case mix group an 'early' episode or a 'later' episode in the patient's current sequence of adjacent Medicare home health payment episodes?"), stating that this was an "early" episode. And you estimated four therapy visits in M0826. You submitted a request for anticipated payment that included these answers.

Later in the episode you discover the patient had two episodes with a home health agency near her sister's home just a few weeks before you admitted her. So this is actually a "later" episode for M0110. She also needed eight therapy visits rather than four.

Question: Do you need to go back and correct the RAP for either of these situations?

Scenario #2: You recertify a patient after Jan. 1 for the third episode of home care. He had two adjacent episodes that are just ending.

Question: Do you count the 2007 episodes when answering M0110 in 2008, thus making this a "later" episode?