OASIS Alert

Published on Fri Aug 17, 2007 PDF

Go well beyond the basics.

With only four months to prepare for dramatic PPS changes effective Jan. 1, home health agencies will need to decide on priorities for the limited training time and money available. Eli has asked training experts to help you get started.

The upcoming changes are the most extensive to PPS since its implementation, says consultant Michelle Enger with Optimal Reimbursement Strategies in Clearwater, FL. Be sure to take advantage of any training or seminars your fiscal intermediary offers or that are available through your state and national home care associations, she suggests.

Focus on improving communication between therapists and nurses, says consultant Pam Warmack with Ruston, LA-based Clinic Connections. Under the new PPS system, "the accuracy of predicting therapy visits will require more communication between disciplines than previously," she explains.

Provide the "big picture" to all your staff and then focus additional training on various operational areas, says consultant Pat Jump with Stewartsville, MN-based Acorn's End Training & Consulting.

Now more than ever, agencies need to ensure that clinicians are "beyond the basic level of competency" with the OASIS assessment, says consultant Jane Gorwin with San Diego, CA-based JG Solutions. One way to do this is to incorporate an interrator reliability competency visit for each clinician each year, she suggests.

1. Educate and train billing staff. They need to know about the new expansion to 153 case mix groups, the drastic changes in the therapy threshold and the deletion of the significant change in condition (SCIC) adjustment, Enger says.

2. Focus on finance. Financial staff need training on how PPS changes will impact their area and affect billing, Jump says.

Strategy: Encourage financial staff to become familiar with the Toy Grouper or other software that helps you determine the financial effect on your agency, she adds.

3. Coding counts. Concentrate on ICD-9 coding now that all six diagnosis coding positions have the potential to capture reimbursement points, Warmack suggests. Also train staff on the coding and M0 item combinations the new system includes, she adds.

4. Concentrate on clinical changes. Clinical staff will need training on OASIS changes, proper diagnosis determination and coding changes -- especially changes affecting case mix and home health resource group re-sults, Jump says.

Caution: Emphasize to clinicians that "how" you answer OASIS questions has not changed, Jump reminds agencies. You still interview and observe the patient and ask for demonstrations of ability. And don't forget to remind clinicians that clinical record documentation must be complete, concise and accurate to support OASIS answers and the care provided, she adds.

5. Emphasize OASIS accuracy. Answering OASIS items accurately will be even more important under the new PPS, experts agree. The expansion of case mix diagnoses, new points for secondary diagnoses and OASIS-based non-routine medical supply reimbursement all emphasize the importance of getting the OASIS right.