Posts tagged ‘recertification’

November 6, 2012

Do a missed recertification if hospitalization at the end of an episode

CMS has clarified some new Q&As. This one deals with hospitalization at the end of an episode.

What OASIS is required when a patient returns home on day 61, in a situation where the patient was admitted to the hospital before or during day 56-60 recert window, is in an inpatient bed longer than 24 hours, but only for diagnostic testing; No Transfer OASIS had been completed?

Answer from CMS: Treat this situation as a missed recertificatior and complete the
recertification as soon as possible after the patient’s return home.
See more Q&As

April 26, 2011

Major improvement or decline require a follow-up assessment

Question: Let’s say that I did a recert on 4/11/2011 and then the patient had an outpatient mastectomy 4/12/2011.  I went to see her on 4/13/2011, which was the first day of her recert. Would this visit be considered a SCIC or can we do as a regular visit and a telephone order for the orders of the mastectomy care?

Lisa says: A follow-up assessment is required for a major improvement or decline in condition, but your policy defines  major improvement or decline. You must complete another follow-up assessment if the circumstances meet your policy. 

February 16, 2011

Follow this rule on recertification dates

I receive a lot of questions about dates for recertifications … what day range can they be done in, and more … this is straight from the CMS Q&As, which are considered official guidance:

Q1. When is a recertification (follow-up) assessment due for a Medicare/Medicaid skilled care patient?

A1. A Medicare/Medicaid skilled-care adult patient who remains on service into a subsequent episode requires a follow-up comprehensive assessment (including OASIS items) during the last 5 days of each 60-day period (days 56-60, counting from the start of care date) until discharged.

I posted this link a few weeks ago, but I’ll put it here again. It s a terrific document to help guide you through tricky  timing sequences: http://www.cms.hhs.gov/OASIS/Downloads/OASISConsiderationsforPPS.pdf