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.


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.