Posts tagged ‘transfer’

December 30, 2011

Gait impairment may impact M1850

CMS has provided some guidance on gait impairment and its potential impact on M1850 …

Question: When completing M1850, Transferring, do I consider the patient’s gait impairment if they must ambulate 12 feet from the bed to get to the closest sitting surface and the need for assistance of another person?
CMS Answer: The need for assistance with gait may impact the M1850, Transferring score if the closest sitting service applicable to the patient’s environment is not next to the bed. M1850 reports the patient’s ability to move from the supine position in bed (or the routine sleeping surface) to a sitting position at the bedside, then some type of standing, stand-pivot, or sliding board transfer to a sitting surface at the bedside. If there is no chair at the bedside, report the ability to transfer from the sleeping surface to whatever sitting surface is applicable to the patient’s environment and need.

If the sleeping surface is in the bedroom and the sitting surface is down the hall in the bathroom and the patient is independent moving from the supine to sitting position, sitting to standing, and then standing to sitting, but requires minimal human assistance or an assistive device to ambulate from the bed to the sitting surface, the appropriate M1850 score would be a “1”. If the patient requires more than minimal assistance or requires both minimal human assistance and an assistive device, the appropriate score would be a “2”.

Looking for the full Q&As?

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.

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March 1, 2011

Even with unexpected discharge, M0090 rules

Question: I understand that for a transfer, or unexpected discharge, the data collected at the last skilled visit is used for the remote documentation.  However, we have had several instances of losing several HHA, PTA, and OTA visit reimbursements, as we are using the last skilled visit as the last billable visit. Is this correct?  Sometimes there are nearly two weeks of forfeited visits due to this rule, which we are not sure we are interpreting correctly.

Lisa says: Your HHA, PTA and OTA visits are billable and should be included on your claim. Completing the OASIS DC is a separate issue. The last qualified clinician who saw the patient has to complete the OASIS based on information obtained at that last visit. But remember that the M0090 date is still the date the assessment was completed which is after the other billable visits were provided.

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.

July 30, 2010

Learn the timing of transfers

This question on transfers recently came to me: We have a home health patient admitted on 7/21 to our agency. On 7/24 he was admitted to inpatient acute care for dehydration, acute renal failure and UTI . However, he was discharged in less than 24 hours. According to the [OASIS] Manual, if it is less than 24hrs, it does not count as admission.
So do we need to do transfer and an ROC?

Lisa says:

To meet the criteria for transfer the patient must:
1) Be admitted as an inpatient;
2) Reside as an inpatient for at least 24 hours (not including time spent in ER); and
3) Be treated for a condition (not for diagnostic purposes).
Your situation does not require a transfer and ROC.

Want to learn more about the specifics of transfers? Go to Chapter 3, Section O (Emergent Care) of the OASIS manual, to see what criteria CMS has put around transfers.

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