OASIS Alert

If your clinicians take M0250 at face value, they could cost your home health agency big bucks.

OASIS item M0250, "Therapies the patient receives at home," is one of the questions that determines how much money your agency will receive for caring for the patient. That means its important that clinicians answer it correctly if not, you could either lose reimbursement you deserve or end up having to return money to Medicare.

The box you mark for this question is the key to determining your reimbursement level, according to the prospective payment system final rule, published in the July 3, 2000 Federal Register. If you mark box 1 (intravenous or infusion therapy [excludes TPN]), it adds 14 points to your case mix score. Box 2 (parenteral nutrition [TPN or lipids]) scores you 20 points; box 3 (enteral nutrition [nasogastric, gastrostomy, jejunostomy, or any other artificial entry into the alimentary canal]) is worth 24 points; and box 4 (none of the above) isnt worth any case mix points.

Its pretty simple to determine whether a patient is on infusion when he begins home care, notes consultant Pat Laff with Laff Associates in Northbrook, IL.

But beyond this initial determination, things can get a bit more complicated. "M0250 has its own little set of nuances," warns Chicago-based consultant Rebecca Friedman Zuber.

"If providers stop at reading the language of the M0 item itself and they dont read the specific response instructions included in the item-by-item tips," they might miss out on reimbursement they deserve, Zuber says. Thats because the item itself mentions only "therapies the patient receives at home."

But the response-specific instructions note that youre "not necessarily restricted to those situations where the patient is receiving the therapy at home," Zuber explains. If the patient receives therapy elsewhere, but you take care of the IV line site, you can get credit.

"If youre doing anything to maintain" an active line, you can get points for it, Zuber advises. For example, if youre flushing a feeding tube thats in active use, you can mark box 3. But if that tube "is an old feeding tube thats not being used," you must mark box 4, Zuber tells Eli.

When determining whether the patient currently receives treatment/nutrition via infusion, the best approaches are to simply ask the patient, perform a nutritional assessment, review the patients past health history and examine the physicians referral orders, the OASIS instrument instructs.

If the patient will begin receiving therapy as a result of your assessment, you may mark the box that indicates which therapy the patient will receive. But "generally, youre not going to have an infusion start during the course of an episode unless youre dealing with hydrations" or something similar, Laff notes.