Posts tagged ‘ROC’

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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October 25, 2011

Answers to when we have to report admissions

Too often we learn about transfers of our patients after the fact. CMS released its 3rd quarter Q&As recently and addressed the item, including the turnaround time when we have to report the transfer.

Question 1: A patient is seen monthly. On a monthly visit, which falls within the last five days of the certification period, the assessing clinician discovers the patient had a qualifying hospital admission since the last monthly visit that our agency was not aware of. Do we complete a Transfer, Resumption and Recert or just the Transfer and Resumption?

Answer 1: When the agency learns of a qualifying Transfer after the patient returned home, a Transfer and Resumption is required within 2 calendar days after learning of the inpatient stay. In this situation, a Transfer is required; and, since the time frame to complete the Resumption overlaps with the timeframe to complete the Recertification, the ROC assessment should be completed, fulfilling both the ROC and Recert requirements.

Looking for all the Q&As?

May 16, 2011

The first visit to the home is the ROC

Some agencies are under the impression that the first visit after the patient returns from an inpatient facility stay has to be the ROC assessment and they believe that any visit prior to the ROC assessment cannot be billed. Both are misunderstandings. The first visit by anyone by your agency, billable or non-billable, is the ROC visit and so the date of that visit is placed in M0032. The ROC assessment has to be completed within 48 hours of return home.

Here is the information from OASIS Q&As

[Q&A ADDED & EDITED 9/09; Previously CMS OCCB 01/09 Q&A #5]

Q15.1. My patient was released from the hospital and needed an injection that evening. The case manager was unavailable and planned to resume care the following day. Could the on call nurse visit and give the injection before the resumption of care assessment is done? Is there a time frame in which care (by an LPN or others) can be provided prior to the completion of the ROC assessment?

A15.1. There are no federal regulatory requirements that prevent an LPN from making the first visit to the patient when resuming care after an inpatient facility stay, but there must be physician orders for the services/treatments provided during that visit. It is not required that the ROC comprehensive assessment be completed on the first visit following the patient’s return home. OASIS guidance states that the Resumption of Care comprehensive assessment must be completed within 2 calendar days after the patient’s return from the inpatient facility. The clinician that completes the ROC comprehensive assessment must be an RN, PT, OT or SLP.

In the case of an unknown hospitalization, a LPN/LVN, aide, or PTA etc makes a regularly scheduled visit and finds that the patient has had a hospitalization meeting the criteria for transfer, calls the agency and reports the hospitalization. The orders you have for the episode are still valid orders after an inpatient admission, so if that regularly scheduled visit has orders that visit is still billable. That visit date is also the date placed in M0032. The qualified clinician has 2 days from the point of acquiring the knowledge of the hospitalization to complete the transfer and the ROC assessments. M0090 is the date the assessment was actually completed.

April 5, 2011

Episode dictates restart of therapy counts

Question: Does the therapy count start over if a patient is admitted to the hospital? Since new therapy evaluations are completed after the post-hospital visit (resumption of care), would a new count begin at this point?
Lisa says:This has to do with the number of therapy visits per episode. The count does not start over after a hospitalization unless you’re in a new episode.
October 29, 2010

Look beyond payment with M1016 and ROC

I wanted to clarify the use of M1016 when you’re changing diagnosis codes at a resumption of care. In this circumstance, would you change the codes in M1016 at recertification or just keep an eye on it?

Part of the answer is looking at when you use OASIS slots with the ROC.

Diagnosis codes at the ROC are placed in M1010, M1016 and M1020/1022/1024 as appropriate.

The other part of the answer lies in looking at the overall impact your ROC may have, not just the payment impact.

Although coding at ROC does not impact your payment (except if the ROC is performed in the last 5 days of the episode) it does impact you risk adjustment on your outcomes.

Because of that impact, it is important to update your codes as necessary at ROC.