Home Health Guide to OASIS-C2 - hcmarketplace.com1 2017 HCPro Home Health Guide to OASIS-C2 3 The...

Home Health Guideto OASIS -C2

Melinda A. Gaboury, COS-C

A Reference For Field Staff

HHPGC2_cover_final.indd 1 1/25/17 12:10 PM

MELINDA A. GABOURY, COS-C



Home Health Guide to OASIS-C2: A Reference for Field Staff is published by HCPro, a division of BLR.

Copyright © 2017 HCPro, a division of BLR

All rights reserved. Printed in the United States of America. 5 4 3 2 1

ISBN: 978-1-68308-188-3

No part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro or the Copyright Clearance Center (978-750-8400). Please notify us immediately if you have received an unauthorized copy.

HCPro provides information resources for the healthcare industry.

HCPro is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks.

Melinda A. Gaboury, COS-C, AuthorTami Swartz, EditorErin Callahan, Vice President, Product Development & Content StrategyElizabeth Petersen, Executive Vice President, HealthcareMatt Sharpe, Production SupervisorVincent Skyers, Design Services DirectorVicki McMahan, Sr. Graphic DesignerJake Kottke, Layout/Graphic DesignJason Gregory, Cover Designer

Advice given is general. Readers should consult professional counsel for specific legal, ethical, or clinical questions.

Arrangements can be made for quantity discounts. For more information, contact:

HCPro100 Winners Circle Suite 300Brentwood, TN 37027Telephone: 800-650-6787 or 781-639-1872Fax: 800-785-9212 Email: [email protected]

Visit HCPro online at www.hcpro.com and www.hcmarketplace.com

© 2017 HCPro

Home Health Guide to OASIS-C2

iii

Contents

Chapter 1: What Is OASIS-C2? ..................................................... 1

Why OASIS? ................................................................................................................4

Who Collects OASIS-C2 Data? ................................................................................4

On Whom Are OASIS-C2 Data Collected? ............................................................4

When Are OASIS-C2 Data Collected? .....................................................................5

How Are OASIS-C2 Data Collected?........................................................................5

Where Are OASIS-C2 Data Collected? ....................................................................6

What’s New in OASIS-C2? .........................................................................................6

Chapter 2: Incorporating OASIS ................................................. 15

Chapter 3: Home Health PPS and OASIS-C2 .............................. 19

Home Health Quality of Care Star Ratings, Value-Based Purchasing, and OASIS-C2...........................................................................................................31

Chapter 4: Patient Tracking Sheet ............................................. 33

Chapter 5: Start-of-Care and Resumption-of-Care Assessments ............................................................................... 37

Chapter 6: Follow-Up and Other Follow-Up Assessments ......... 43

Chapter 7: Transfer and Discharge Assessments ....................... 47

Chapter 8: General Instructions for Completion of the OASIS-C2 M/GG Items ............................................................... 53

M/GG: Item by Item .................................................................................................56

CHAPTER 1

What Is OASIS-C2?

What Is OASIS-C2?C

HA

PTER

1

© 2017 HCPro


3

The Outcome and Assessment Information Set (OASIS) is a set of data items that

was originally developed to monitor health outcomes. Beginning October 1,

2000, the OASIS data set became a key factor in determining reimbursement for

a home health episode under the Medicare prospective payment system (PPS).

Effective January 1, 2010, the data set was updated to OASIS-C, and effective

January 1, 2015, it was updated yet again to OASIS-C1. Further revisions, to coin-

cide with implementation of ICD-10-CM, were effective October 1, 2015. The

most recent update is OASIS-C2, effective January 1, 2017. This update includes

many changes that will meet the standardization required for other post-acute

care data sets. Although the OASIS-C2 data set is not a complete, comprehen-

sive assessment instrument, it must be fully integrated into every agency’s com-

prehensive assessment forms (see Chapter 2 for more information).

Outcomes derived from OASIS-C2 data are defined as those that measure

changes in a patient’s health status between points in time. For example, an

OASIS-based outcome might compare a patient’s dyspneic state at the point of

admission to home health to the patient’s dyspneic state at the point of dis-

charge from home health. OASIS-based outcomes form the foundation of Out-

come-Based Quality Improvement systems (see Chapter 3 for more information).

They also serve as measures in other programs. For example, on January 1, 2016,

the five-year Value-Based Purchasing (VBP) Pilot went into effect in nine states,

and VBP is measured, in large part, by OASIS-based outcomes (see Chapter 4 for

more information).

Additionally, home health Medicare PPS reimbursement is based on the calcula-

tion of one of 153 Home Health Resource Groups (HHRG), which are assigned

based on responses to 19 key questions from OASIS-C2. Although numerous

types of adjustments can result in a higher or lower reimbursement than the

HHRG calculates, the HHRG always serves as the foundation for the reimburse-

ment (see Chapter 3 for more information): It is converted to a HIPPS (Health

Insurance Prospective Payment System) code that is reflected on the claim for

payment.

What Is OASIS-C2?

CH

APTE

R

1

© 2017 HCPro4


Why OASIS?

OASIS was chosen to be the basis for home health outcomes and reimburse-

ment following a five-year national research program. The OASIS data set was

tested in two demonstration projects, a national project with 50 agencies and a

New York state project with 22 agencies. Nearly 200 agencies across the country

tested and contributed to the refinement of the data, which began with the orig-

inal report from The Research Center at the University of Colorado in 1994 and

has been reviewed, revised, and expanded as a result of recommendations by

the Centers for Medicare & Medicaid Services (CMS) and the outcomes of the

demonstration projects.

Who Collects OASIS-C2 Data?

The clinician who performs the home care visit collects the OASIS data. This per-

son can be an RN, a registered physical therapist, or a speech-language pathol-

ogist, any of whom can complete any type of OASIS assessment. A registered

occupational therapist (OT) may collect the data for any assessment type except

for the start-of-care assessment, which requires performing care in the home

when OT is referred. Note that this OT restriction applies to patients for whom

Medicare is the payer; however, if an agency receives a referral for OT only and

the payer is strictly commercial insurance or private pay, then the OT can com-

plete the start-of-care assessment. Licensed practical/vocational nurses, therapy

assistants, social workers, and home health aides are all prohibited from com-

pleting the OASIS documents.

On Whom Are OASIS-C2 Data Collected?

OASIS-C2 data are collected on any patient who is receiving skilled care from a

Medicare-certified home health agency and whose payer for the services is

Medicare Traditional, a Medicare Advantage Managed Care Plan, or a Skilled

What Is OASIS-C2?C

HA

PTER

1

© 2017 HCPro


5

Medicaid program. Effective December 2003, if the patient’s services payment

will be made by a non-Medicare payer, the OASIS-C2 data collection is not

required. If the patient has a non-Medicare primary payer and the patient is also

covered by Medicare secondary benefits, OASIS-C2 data must be collected. The

OASIS-C2 data are collected only for adult, non-maternity patients who are 18

years of age and older. Patients who are receiving only personal care, home-

maker, or chore services are excluded from the OASIS-C2 data collection

requirements.

When Are OASIS-C2 Data Collected?

OASIS-C2 data collection is required at different intervals throughout the

patient’s care. Depending on the type of assessment, data collection takes place

during different time frames, as shown in Table 1.1.

How Are OASIS-C2 Data Collected?

OASIS-C2 data are to be collected in the patient’s home as a combination of

interactions and interviews with the patients and caregivers, observation, and

measurement.

Observation through sight, sound, smell, and touch will allow for additional data

collection. Measurement of such data is also necessary when warranted. Exam-

ples include the following:

• Height

• Weight

• Joint range of motion

Observing the patient is imperative when addressing certain parts of the assess-

ment, such as functional status. Asking a patient to ambulate to the kitchen to

What Is OASIS-C2?

CH

APTE

R

1

© 2017 HCPro6


measure his or her ability to ambulate independently, and for what distance,

would be an example of combining observation and measurement. Be very clear

that the interview/interaction should supplement, but not replace, observation/

measurement.

Where Are OASIS-C2 Data Collected?

OASIS data are collected wherever the patient is receiving care (including the

home). The OASIS-C2 documents should not be an afterthought. Interaction,

interview, observation, and measurement should all be part of the process. It is

extremely important that the data be collected during the visits and serve as a

true reflection of the patient’s health status.

What’s New in OASIS-C2?

The OASIS-C2 represents one of the most comprehensive revisions to OASIS

since its original release. See Table 1.2 for a summary of the types of revisions

made to OASIS. An “X” in a column indicates that a change has been made to

the OASIS-C2 Data Set and/or the OASIS-C2 Guidance Manual.

What Is OASIS-C2?C

HA

PTER

1

© 2017 HCPro


7

Table 1.1 Assessment time frames

Type of assessment

When to complete

Time frame to complete

Reason for assessment (RFA)

Start of care (SOC) Admission

of patient

Initiated within 48

hours of referral

and completed

within five days

of the SOC date

(M0030)

1

Resumption

of care

Following inpa-

tient stay of 24

hours or more, for

care other than

diagnostic tests

Within 48 hours

of patient’s return

home from inpa-

tient facility

3

Recertification—

follow-up

Every 60 days—

when patient is

continuing care

Within the past

five days of the

current episode

(days 56–60)

4

Other follow-up Any time a patient

experiences a

change in condi-

tion as defined in

agency policy

Within 48 hours of

the change

in condition

5

Transfer to inpa-

tient facility—

not discharged

from agency

Following a trans-

fer to an inpa-

tient facility and

placing patient

on hold for home

health

Within 48 hours

of transfer date

(M0906)

6

What Is OASIS-C2?

CH

APTE

R

1

© 2017 HCPro8


Type of assessment

When to complete

Time frame to complete

Reason for assessment (RFA)

Transfer to inpa-

tient facility—

discharged

from agency

Following a trans-

fer to inpatient fa-

cility, and patient

is discharged from

home health

Within 48 hours

of transfer date

(M0906)

7

Death at home Following pa-

tient’s death at

home

Within 48 hours

of the death date

(M0906)

8

Discharged

from agency—

not to an

inpatient facility

Following pa-

tient’s discharge

from home health

Within 48 hours of

the discharge date

(M0906)

9

Table 1.1 Assessment time frames (cont.)

What Is OASIS-C2?C

HA

PTER

1

© 2017 HCPro


9

Table 1.2 OASIS-C2 revisions

OA

SIS

-C2

dat

a se

tO

ASI

S-C

2 G

uid

ance

Man

ual

OA

SIS-

C1

item

nu

mb

er

OA

SIS-

C2

item

nu

mb

er

New

or

del

eted

it

em

New

it

em

num

ber

Item

w

ord

ing

ch

ang

e

Co

nver

ted

re

spo

nse

spac

es t

o b

ox(e

s)

Skip

p

atte

rn

chan

ge

Item

in

tent

Tim

e p

oin

tsR

esp

ons

e-sp

ecifi

c in

stru

ctio

ns

Dat

a so

urce

s/

reso

urce

s

M00

10M

0010

X

M00

14M

0014

X

M00

16M

0016

X

M00

18M

0018

X

M00

20M

0020

X

M00

30M

0030

XX

M00

32M

0032

XX

M00

40M

0040

X

M00

50M

0050

X

M00

60M

0060

X

M00

63M

0063

X

M00

64M

0064

X

M00

65M

0065

X

M00

66M

0066

XX

M00

69M

0069

XX

M00

80M

0080

X

M00

90M

0090

XX

M01

00M

0100

X

M01

02M

0102

XX

M01

04M

0104

XX

What Is OASIS-C2?

CH

APTE

R

1

© 2017 HCPro10


OA

SIS-

C1

item

nu

mb

er

OA

SIS-

C2

item

nu

mb

er

New

or

del

eted

it

em

New

it

em

num

ber

Item

w

ord

ing

ch

ang

e

Co

nver

ted

re

spo

nse

spac

es t

o b

ox(e

s)

Skip

p

atte

rn

chan

ge

Item

in

tent

Tim

e p

oin

tsR

esp

ons

e-sp

ecifi

c in

stru

ctio

ns

Dat

a so

urce

s/

reso

urce

s

M01

10M

0110

X

M01

40M

0140

M01

50M

0150

M09

03M

0903

XX

X

M09

06M

0906

X

M10

00M

1000

X

M10

05M

1005

XX

M10

10M

1010

M10

11M

1011

XX

M10

17M

1017

XX

M10

18M

1018

X

M10

21M

1021

XX

M10

23M

1023

XX

M10

25M

1025

XX

M10

28N

EW

XX

XX

M10

30M

1030

M10

33M

1033

M10

34M

1034

XX

M10

36M

1036

M10

41M

1041

X

M10

46M

1046

XX

Table 1.2 OASIS-C2 revisions (cont.)

What Is OASIS-C2?C

HA

PTER

1

© 2017 HCPro


11

OA

SIS-

C1

item

nu

mb

er

OA

SIS-

C2

item

nu

mb

er

New

or

del

eted

it

em

New

it

em

num

ber

Item

w

ord

ing

ch

ang

e

Co

nver

ted

re

spo

nse

spac

es t

o b

ox(e

s)

Skip

p

atte

rn

chan

ge

Item

in

tent

Tim

e p

oin

tsR

esp

ons

e-sp

ecifi

c in

stru

ctio

ns

Dat

a so

urce

s/

reso

urce

s

M10

51M

1051

XX

M10

56M

1056

XX

M10

60N

EW

XX

XX

M11

00M

1100

X

M12

00M

1200

XX

M12

10M

1210

X

M12

20M

1220

X

M12

30M

1230

X

M12

40M

1240

XX

M12

42M

1242

X

M13

00M

1300

XX

M13

02M

1302

XX

M13

06M

1306

XX

XX

M13

07M

1307

XX

XX

M13

08M

1311

XX

XX

X

M13

09M

1313

XX

XX

M13

20M

1320

XX

X

M13

22M

1322

XX

XX

M13

24M

1324

XX

M13

30M

1330

X


What Is OASIS-C2?

CH

APTE

R

1

© 2017 HCPro12


OA

SIS-

C1

item

nu

mb

er

OA

SIS-

C2

item

nu

mb

er

New

or

del

eted

it

em

New

it

em

num

ber

Item

w

ord

ing

ch

ang

e

Co

nver

ted

re

spo

nse

spac

es t

o b

ox(e

s)

Skip

p

atte

rn

chan

ge

Item

in

tent

Tim

e p

oin

tsR

esp

ons

e-sp

ecifi

c in

stru

ctio

ns

Dat

a so

urce

s/

reso

urce

s

M13

32M

1332

X

M13

34M

1334

X

M13

40M

1340

XX

M13

42M

1342

XX

M13

50M

1350

XX

M14

00M

1400

X

M14

10M

1410

M15

00M

1501

XX

XX

X

M15

10M

1511

XX

M16

00M

1600

XX

M16

10M

1610

X

M16

15M

1615

X

M16

20M

1620

X

M16

30M

1630

XX

M17

00M

1700

XX

M17

10M

1710

XX

M17

20M

1720

XX

M17

30M

1730

X

M17

40M

1740

X

M17

45M

1745

XX

M17

50M

1750

X


What Is OASIS-C2?C

HA

PTER

1

© 2017 HCPro


13

OA

SIS-

C1

item

nu

mb

er

OA

SIS-

C2

item

nu

mb

er

New

or

del

eted

it

em

New

it

em

num

ber

Item

w

ord

ing

ch

ang

e

Co

nver

ted

re

spo

nse

spac

es t

o b

ox(e

s)

Skip

p

atte

rn

chan

ge

Item

in

tent

Tim

e p

oin

tsR

esp

ons

e-sp

ecifi

c in

stru

ctio

ns

Dat

a so

urce

s/

reso

urce

s

M18

00M

1800

X

M18

10M

1810

X

M18

20M

1820

XX

M18

30M

1830

X

M18

40M

1840

XX

M18

45M

1845

X

M18

50M

1850

X

GG

0170

CN

EW

XX

XX

M18

60M

1860

X

M18

70M

1870

X

M18

80M

1880

X

M18

90M

1890

X

M19

00M

1900

XX

M19

10M

1910

X

M20

00M

2001

XX

XX

X

M20

02M

2003

XX

X

M20

04M

2005

XX

XX

M20

10M

2010

X

M20

15M

2016

XX

XX

M20

20M

2020

XX

M20

30M

2030

XX


What Is OASIS-C2?

CH

APTE

R

1

© 2017 HCPro14


OA

SIS-

C1

item

nu

mb

er

OA

SIS-

C2

item

nu

mb

er

New

or

del

eted

it

em

New

it

em

num

ber

Item

w

ord

ing

ch

ang

e

Co

nver

ted

re

spo

nse

spac

es t

o b

ox(e

s)

Skip

p

atte

rn

chan

ge

Item

in

tent

Tim

e p

oin

tsR

esp

ons

e-sp

ecifi

c in

stru

ctio

ns

Dat

a so

urce

s/

reso

urce

s

M20

40M

2040

XX

X

M21

02M

2102

XX

X

M21

10M

2110

X

M22

00M

2200

XX

M22

50M

2250

M23

00M

2301

XX

XX

X

M23

10M

2310

X

M24

00M

2401

XX

M24

10M

2410

X

M24

20M

2420

X

M24

30M

2430




Home Health Guide to OASIS-C2: A Reference for Field Staff walks home health providers through OASIS-C2 documentation and the changes made to the OASIS data set by CMS. This book includes step-by-step instructions for filling out each OASIS-C2 item, explanations of how OASIS items fit into various assessments, a breakdown of how the data collection affects reimbursement, and troubleshooting tips to avoid incorrect payments, denials, and fines. This edition also points out items related to quality of patient care star ratings, offers case-mix tips, and provides examples with diagnosis to properly document.

HHPGC2

100 Winners Circle, Suite 300Brentwood, TN 37027www.hcmarketplace.com

Melinda A. Gaboury, COS-C

HHPGC2_cover_final.indd 2 1/25/17 12:10 PM

Home Health Guide to OASIS-C2 - hcmarketplace.com1 2017 HCPro Home Health Guide to OASIS-C2 3 The...

Documents

Transcript of Home Health Guide to OASIS-C2 - hcmarketplace.com1 2017 HCPro Home Health Guide to OASIS-C2 3 The...