Posts tagged ‘soc’

October 12, 2012

Does N/A in one place mean N/A in all?

Question: If a M2250 question is answered N/A on the SOC or ROC, would M2400 on the transfer or DCO automatically be N/A as well?

For example:  M2250 (E) pain was answered N/A on the SOC because no pain was identified. Then sometime during the episode the patient fell and now has pain in the Rt knee r/t the fall. The patient is placed on a pain medication for the acute pain. The nurse identifies the need for pain interventions to monitor and mitigate the pain.  The nurse uses a standardized pain assessment tool to rate the pain, writes a verbal order to add pain interventions to the POC, and implements the interventions.  At the discharge OASIS, would M2400 (D) be answered N/A because no other OASIS was performed since the SOC and on the SOC the POC synopsis (E) was N/A OR since the nurse addressed the pain by assessing the patient’s pain with the standardized tool, wrote the VO to include the interventions in the POC and implemented them, could she answer #1 on M2400 ?

Lisa says: Intermittent verbal orders count as well, so if you get an order for assessment and intervention sometime in the episode and the interventions are completed as you described in your scenario, then the answer is ‘yes’ on the discharge.

Formal assessment does mean the standardized and/or validated tools contained in those specific M items you mentioned. The trick is that if the last assessment done was the recert, those M items are not part of the recert. However, N/A cannot apply if no formal assessments were done, so when discharging and the last OASIS was a recert the answer has to be either yes or no.

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August 31, 2012

Medicare cares whether a visit was billable

Question: We have a patient that did not get a face-to-face until after the 30-day mark after SOC.  I know I can go 30 days prior to when the face-to-face took place. When I count back, the patient was seen by a therapist that day but was not seen by a skilled nurse until several days later.  Do I have to have the clinician do an OASIS/485 for the date she saw? The specifics:

HH original SOC 6/29
Face to Face encounter 8/9
Possible new SOC 7/11 (30 days prior to 8/9)
SN saw 7/9, therapy saw 7/11, SN saw 7/20

Do all consent forms need to be redated to new SOC date as well?  New 485, new OASIS?

Lisa says: Your new SOC should be generated based on a date of 7/11 (30 days back from F2F was 7/11). 7/11 is chosen because it is the first eligible date and the first billable visit was made. Medicare doesn’t care who made the visit as long as it was billable.
 
To generate a new SOC assessment, any qualified clinician can sit down with the old SOC and complete the new one based on the same answers with updates to M0110 and M2200. A new 485 will need to completed with updated orders to reflect the 60 days beginning with 7/11 as the “from” date. M0090 will be the actual date that the new SOC is generated so you will receive late warnings.
 
Medicare does not speak to new consents, but I suggest you at least have some kind of communication with the patient in the interest of patient rights. This could get signed at the next visit. For example:

Dear {Patient},

A visit with your physician within a certain time frame when beginning care with a home health agency is a condition of payment for the home health agency. Because you did not see your physician until {date}, we have a new start of care date for you and the care previous to the date is non-covered by Medicare. (You are not responsible for payment.)

We will continue to provide you care under the previous consent forms signed by you or your representative. Please sign this letter to indicate your receipt of this information.

Regards.

Administrator Signature                                                              Patient Signature

May 13, 2011

How often do we do face-to-face?

Question: Can you please clarify face-to-face frequency. Is it only on start of care or is it required again after start of care?
Lisa says: Within 90 days prior to SOC or 30 days after SOC.  No Requirement for reverts etc. 
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May 3, 2011

OTs cannot do SOC OASIS assessment

Question: Can a qualified Occupational Therapist perform/complete the OASIS SOC/ROC assessment on Medicare and Medicaid patients??

Lisa says: A qualified occupational therapist cannot perform the SOC comprehensive assessment, but can complete the OASIS at any other timepoint.

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March 16, 2011

G codes focus on the most important reason for admission

Question: What G-code would be used for initial patient admission into a HHA? Patient is discharged from hospital with CHF exacerbation, new meds. SN does complete assessment, reviews all new and continued medications, medication and disease process teaching, etc., and completes the OASIS, 485, etc.
Lisa says: Assign the G code that reflects what was most important about the visit remembering that the OASIS assessment is not, by itself, billable.
December 17, 2010

Redo your SOC when patient returns from facility

Question: I remember that you said if you were doing a SOC on a patient and they were ill enough to go to the hospital that day the SOC was started that you didn’t want to claim the hospitalization for your agency. However, I don’t remember what you said to do and I can’t find it in my notes. Can you help?

Lisa says: The answer depends on whether the patient is admitted.
If admitted, you want to keep the assessment in a medical record and document the circumstances. No transfer is required. When the patient returns from the facility, re-do the SOC.

October 16, 2010

SOC dates, SOC for OASIS … how do they work, again?

I get timing questions all the time regarding SOC. Here is a recent one that should help other agencies tweak their processes or know that they’re on steady ground with CMS.

Question: Our staff are being assigned a “first visit” that will establish the SOC date (first visit being a billable visit), but not doing the SOC OASIS on that first visit.  The SOC OASIS will be done within five days.

Is this in accordance with guidelines? And here is a date-specific example: If “first visit” is 9/27/10, does that mean SOC OASIS must be completed by 10/01(include 9/27) or 10/2 (5 days after soc)?

Lisa says: Yes, the described practice is fine. The SOC date is the first billable visit. The OASIS can be done as late as five days after the SOC. In your example, if first billable visit (SOC) is 9/27, then OASIS has to be completed by 10/2. SOC counts as day zero.

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August 13, 2010

M0090, M1350, and M2004 questions answered

Here are answers to three recent questions that I have fielded on OASIS:

For M0090, we’ve heard that is the date that we  (RNs) complete the OASIS assessment, including getting frequency from PT, OT, ST, and response from MD if any abnormalities with meds are found … this occurs all in a five-day window. Others are teaching to put the M0o90 date as the date we (RNs) complete the assessments without info from others. How do we fill this item?

Lisa says: The assessing clinician has six days to complete the SOC assessment.  (Assessment is day zero + five days.) This time period includes collaboration with other clinicians, i.e., M2200, and waiting for the physician’s response for M2250. M0090 is the date the assessment is completed, and it is not complete until that info has been received.

If you address a wound under Wound 1 in M1350, do you answer as a ‘yes’? Or does this question only apply to the previous questions about ulcers. If you have a PICC line that you address later in the SOC, do you answer M1350 as ‘yes’?

Lisa says: M1350 includes any wounds or skin lesions OTHER than the pressure ulcers, stasis ulcers, surgical wounds already addressed, and bowel ostomies, which are also addressed in another item. The answer ‘yes’ on M1350 means that the skin lesion or wound requires intervention and assessment. PICC lines that require intervention ARE included.

Let’s say that the SOC and DC OASIS are all that were completed when answering M2004. You answered it as ‘no’ on the SOC because you did not receive a response from the MD in 24 hours, you have addressed all issues, and no new issues have appeared. Do you answer this as ‘NA’ or ‘no’ if the MD did not respond in the 24 hours from the SOC OASIS?
Lisa says: If the physician does not respond within one calendar day (which can be longer than 24 hours, given the way CMS has defined it) the answer has to be ‘no’ on M2004. If there were no issues identified, then ‘NA’ would be the correct answer. Keep alert to news on this, as some recent CMS guidance could muddy this answer.

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July 13, 2010

10 days for comprehensive assessment? 5? 6?

I didn’t realize that the language in the OASIS Guidance Manual and the Conditions of Participation are slightly different, and that has caused some confusion with HHAs.

The Guidance Manual states that “At the start of care time point, the comprehensive assessment should be completed within five days of the start of care date”.

Conditions of Participation (484.55(b)) states that the assessment must be complete “no later than five calendar days after the start of care.”

Do you have 10 days … five days before and five after the SOC (using “within” to mean that in the OASIS manual?) Or five days … five calendar days, according to the CoP?

CMS has clarified that SOC is day zero, so you have six days to complete the assessment.

Here are a couple of examples where knowing this is useful and can keep you in compliance:

M2250 requires that the agency communicate findings to the physician and get orders for the best practices applicable, e.g., physician-ordered patient specific parameters, assessment and diabetic foot care. The agency has the 6 days to get the assessment done and get verbal orders back from the physician before you have to check ‘yes.’

M2010 requires that education be provided at SOC on high risk meds. You have those six days to complete teaching.

M0090 can be a day other than the day of initial visit … it can take more than one visit to complete the assessment.  Consider this example: You have a therapy-only case, and therapy does the initial eval on July 9; that’s the SOC. Therapy won’t do the OASIS, so nursing will come Monday the 11th.

The OASIS has to have a M0090 date of no later than the 14th. The therapist may do a falls risk assessment, but that doesn’t count toward the best practice. The falls risk assessment has to be completed by the assessing clinician within the timeframe of the SOC.

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