Home Health Guide to OASIS-C2

Transcription

1 Home Health Guide to OASIS-C2 A Reference For Field Staff Melinda A. Gaboury, COS-C

2 Home Health Guide to OASIS-C2 A Reference For Field Staff MELINDA A. GABOURY, COS-C

3 : A Reference for Field Staff is published by HCPro, a division of BLR. Copyright, a division of BLR All rights reserved. Printed in the United States of America ISBN: No part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro or the Copyright Clearance Center ( ). Please notify us immediately if you have received an unauthorized copy. HCPro provides information resources for the healthcare industry. HCPro is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks. Melinda A. Gaboury, COS-C, Author Tami Swartz, Editor Erin Callahan, Vice President, Product Development & Content Strategy Elizabeth Petersen, Executive Vice President, Healthcare Matt Sharpe, Production Supervisor Vincent Skyers, Design Services Director Vicki McMahan, Sr. Graphic Designer Jake Kottke, Layout/Graphic Design Jason Gregory, Cover Designer Advice given is general. Readers should consult professional counsel for specific legal, ethical, or clinical questions. Arrangements can be made for quantity discounts. For more information, contact: HCPro 00 Winners Circle Suite 300 Brentwood, TN Telephone: or Fax: customerservice@hcpro.com Visit HCPro online at and

4 Contents Chapter :... Why OASIS?...4 Who Collects OASIS-C2 Data?...4 On Whom Are OASIS-C2 Data Collected?...4 When Are OASIS-C2 Data Collected?...5 How Are OASIS-C2 Data Collected?...5 Where Are OASIS-C2 Data Collected?...6 What s New in OASIS-C2?...6 Chapter 2: Incorporating OASIS... 5 Chapter 3: Home Health PPS and OASIS-C Home Health Quality of Care Star Ratings, Value-Based Purchasing, and OASIS-C2...3 Chapter 4: Patient Tracking Sheet Chapter 5: Start-of-Care and Resumption-of-Care Assessments Chapter 6: Follow-Up and Other Follow-Up Assessments Chapter 7: Transfer and Discharge Assessments Chapter 8: General Instructions for Completion of the OASIS-C2 M/GG s M/GG: by...56 iii

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8 The Outcome and Assessment Information Set (OASIS) is a set of data s that was originally developed to monitor health outcomes. Beginning October, 2000, the OASIS data set became a key factor in determining reimbursement for a home health episode under the Medicare prospective payment system (PPS). Effective January, 200, the data set was updated to OASIS-C, and effective January, 205, it was updated yet again to OASIS-C. Further revisions, to coincide with implementation of ICD-0-CM, were effective October, 205. The most recent update is OASIS-C2, effective January, 207. This update includes many s that will meet the standardization required for other post-acute care data sets. Although the OASIS-C2 data set is not a complete, comprehensive assessment instrument, it must be fully integrated into every agency s comprehensive assessment forms (see Chapter 2 for more information). Outcomes derived from OASIS-C2 data are defined as those that measure s in a patient s health status between points in time. For example, an OASIS-based outcome might compare a patient s dyspneic state at the point of admission to home health to the patient s dyspneic state at the point of discharge from home health. OASIS-based outcomes form the foundation of Outcome-Based Quality Improvement systems (see Chapter 3 for more information). They also serve as measures in other programs. For example, on January, 206, the five-year Value-Based Purchasing (VBP) Pilot went into effect in nine states, and VBP is measured, in large part, by OASIS-based outcomes (see Chapter 4 for more information). Additionally, home health Medicare PPS reimbursement is based on the calculation of one of 53 Home Health Resource Groups (HHRG), which are assigned based on responses to 9 key questions from OASIS-C2. Although numerous types of adjustments can result in a higher or lower reimbursement than the HHRG calculates, the HHRG always serves as the foundation for the reimbursement (see Chapter 3 for more information): It is converted to a HIPPS (Health Insurance Prospective Payment System) code that is reflected on the claim for payment. 3

9 Why OASIS? OASIS was chosen to be the basis for home health outcomes and reimbursement following a five-year national research program. The OASIS data set was tested in two demonstration projects, a national project with 50 agencies and a New York state project with 22 agencies. Nearly 200 agencies across the country tested and contributed to the refinement of the data, which began with the original report from The Research Center at the University of Colorado in 994 and has been reviewed, revised, and expanded as a result of recommendations by the Centers for Medicare & Medicaid Services (CMS) and the outcomes of the demonstration projects. Who Collects OASIS-C2 Data? The clinician who performs the home care visit collects the OASIS data. This person can be an RN, a registered physical therapist, or a speech-language pathologist, any of whom can complete any type of OASIS assessment. A registered occupational therapist (OT) may collect the data for any assessment type except for the start-of-care assessment, which requires performing care in the home when OT is referred. Note that this OT restriction applies to patients for whom Medicare is the payer; however, if an agency receives a referral for OT only and the payer is strictly commercial insurance or private pay, then the OT can complete the start-of-care assessment. Licensed practical/vocational nurses, therapy assistants, social workers, and home health aides are all prohibited from completing the OASIS documents. On Whom Are OASIS-C2 Data Collected? OASIS-C2 data are collected on any patient who is receiving skilled care from a Medicare-certified home health agency and whose payer for the services is Medicare Traditional, a Medicare Advantage Managed Care Plan, or a Skilled 4

10 Medicaid program. Effective December 2003, if the patient s services payment will be made by a non-medicare payer, the OASIS-C2 data collection is not required. If the patient has a non-medicare primary payer and the patient is also covered by Medicare secondary benefits, OASIS-C2 data must be collected. The OASIS-C2 data are collected only for adult, non-maternity patients who are 8 years of age and older. Patients who are receiving only personal care, homemaker, or chore services are excluded from the OASIS-C2 data collection requirements. When Are OASIS-C2 Data Collected? OASIS-C2 data collection is required at different intervals throughout the patient s care. Depending on the type of assessment, data collection takes place during different time frames, as shown in Table.. How Are OASIS-C2 Data Collected? OASIS-C2 data are to be collected in the patient s home as a combination of interactions and interviews with the patients and caregivers, observation, and measurement. Observation through sight, sound, smell, and touch will allow for additional data collection. Measurement of such data is also necessary when warranted. Examples include the following: Height Weight Joint range of motion Observing the patient is imperative when addressing certain parts of the assessment, such as functional status. Asking a patient to ambulate to the kitchen to 5

11 measure his or her ability to ambulate independently, and for what distance, would be an example of combining observation and measurement. Be very clear that the interview/interaction should supplement, but not replace, observation/ measurement. Where Are OASIS-C2 Data Collected? OASIS data are collected wherever the patient is receiving care (including the home). The OASIS-C2 documents should not be an afterthought. Interaction, interview, observation, and measurement should all be part of the process. It is extremely important that the data be collected during the visits and serve as a true reflection of the patient s health status. What s New in OASIS-C2? The OASIS-C2 represents one of the most comprehensive revisions to OASIS since its original release. See Table.2 for a summary of the types of revisions made to OASIS. An X in a column indicates that a has been made to the OASIS-C2 Data Set and/or the OASIS-C2 Guidance Manual. 6

12 Table. Assessment time frames Type of assessment When to complete Time frame to complete Reason for assessment (RFA) Start of care (SOC) Admission Initiated within 48 of patient hours of referral and completed within five days of the SOC date (M0030) Resumption Following inpa- Within 48 hours 3 of care tient stay of 24 of patient s return hours or more, for home from inpa- care other than tient facility diagnostic tests Recertification Every 60 days Within the past 4 follow-up when patient is five days of the continuing care current episode (days 56 60) Other follow-up Any time a patient Within 48 hours of 5 experiences a the in condi- in condition tion as defined in agency policy Transfer to inpa- Following a trans- Within 48 hours 6 tient facility fer to an inpa- of transfer date not discharged tient facility and (M0906) from agency placing patient on hold for home health 7

13 Table. Assessment time frames (cont.) Type of assessment When to complete Time frame to complete Reason for assessment (RFA) Transfer to inpa- Following a trans- Within 48 hours 7 tient facility fer to inpatient fa- of transfer date discharged cility, and patient (M0906) from agency is discharged from home health Death at home Following pa- Within 48 hours 8 tient s death at of the death date home (M0906) Discharged Following pa- Within 48 hours of 9 from agency tient s discharge the discharge date not to an from home health (M0906) inpatient facility 8

14 Table.2 OASIS-C2 revisions OASIS-C OASIS-C2 New or deleted New OASIS-C2 data set OASIS-C2 Guidance Manual wording M000 M000 X M004 M004 X M006 M006 X M008 M008 X M0020 M0020 X Converted response spaces to box(es) Skip pattern intent Time points M0030 M0030 X X M0032 M0032 X X M0040 M0040 X M0050 M0050 X M0060 M0060 X M0063 M0063 X M0064 M0064 X M0065 M0065 X M0066 M0066 X X Responsespecific instructions M0069 M0069 X X M0080 M0080 X M0090 M0090 X X M000 M000 X M002 M002 X X M004 M004 X X Data sources/ resources 9

15 Table.2 OASIS-C2 revisions (cont.) OASIS-C OASIS-C2 New or deleted New wording M00 M00 X M040 M040 M050 M050 Converted response spaces to box(es) Skip pattern intent Time points M0903 M0903 X X X M0906 M0906 X M000 M000 X M005 M005 X X M00 M00 M0 M0 X X M07 M07 X X M08 M08 X M02 M02 X X M023 M023 X X M025 M025 X X M030 M030 M033 M033 Responsespecific instructions M028 NEW X X X X M034 M034 X X M036 M036 M04 M04 X M046 M046 X X Data sources/ resources 0

16 Table.2 OASIS-C2 revisions (cont.) OASIS-C OASIS-C2 New or deleted New wording Converted response spaces to box(es) Skip pattern intent Time points M05 M05 X X M056 M056 X X Responsespecific instructions M060 NEW X X X X M00 M00 X M200 M200 X X M20 M20 X M220 M220 X M230 M230 X M240 M240 X X M242 M242 X M300 M300 X X M302 M302 X X M306 M306 X X X X M307 M307 X X X X M308 M3 X X X X X M309 M33 X X X X M320 M320 X X X M322 M322 X X X X M324 M324 X X M330 M330 X Data sources/ resources

17 Table.2 OASIS-C2 revisions (cont.) OASIS-C OASIS-C2 New or deleted New wording M332 M332 X M334 M334 X Converted response spaces to box(es) Skip pattern intent Time points M340 M340 X X M342 M342 X X M350 M350 X X M400 M400 X M40 M40 M500 M50 X X X X X M50 M5 X X M600 M600 X X M60 M60 X M65 M65 X M620 M620 X M630 M630 X X M700 M700 X X M70 M70 X X M720 M720 X X M730 M730 X M740 M740 X M745 M745 X X M750 M750 X Responsespecific instructions Data sources/ resources 2

18 Table.2 OASIS-C2 revisions (cont.) OASIS-C OASIS-C2 New or deleted New wording M800 M800 X M80 M80 X Converted response spaces to box(es) Skip pattern intent Time points M820 M820 X X M830 M830 X M840 M840 X X M845 M845 X M850 M850 X Responsespecific instructions GG070C NEW X X X X M860 M860 X M870 M870 X M880 M880 X M890 M890 X M900 M900 X X M90 M90 X M2000 M200 X X X X X M2002 M2003 X X X M2004 M2005 X X X X M200 M200 X M205 M206 X X X X M2020 M2020 X X M2030 M2030 X X Data sources/ resources 3

19 Table.2 OASIS-C2 revisions (cont.) OASIS-C OASIS-C2 New or deleted New wording Converted response spaces to box(es) Skip pattern intent Time points M2040 M2040 X X X M202 M202 X X X M20 M20 X M2200 M2200 X X M2250 M2250 M2300 M230 X X X X X M230 M230 X M2400 M240 X X M240 M240 X M2420 M2420 X M2430 M2430 Responsespecific instructions Data sources/ resources 4

20 Home Health Guide to OASIS-C2 A Reference For Field Staff Melinda A. Gaboury, COS-C Home Health Guide to OASIS-C2: A Reference for Field Staff walks home health providers through OASIS-C2 documentation and the s made to the OASIS data set by CMS. This book includes step-by-step instructions for filling out each OASIS-C2, explanations of how OASIS s fit into various assessments, a breakdown of how the data collection affects reimbursement, and troubleshooting tips to avoid incorrect payments, denials, and fines. This edition also points out s related to quality of patient care star ratings, offers case-mix tips, and provides examples with diagnosis to properly document. HHPGC2 00 Winners Circle, Suite 300 Brentwood, TN