Today marks the release of the January 2013 CMS Quarterly Q&As, available for download: CMS Quarterly Q&As - April 2013 This quarterly update contains 10 new Q&AS containing the latest OASIS-C guidance from CMS, including instruction related to:
detailing when the ability to access needed items and/or location where the task is performed is included/excluded from ADL/IADL items
compliance issues related to the use of paper-based standardized assessment tools for meeting CMS process measure criteria
impact of medical restrictions in specific situations concerning M1242 Frequency Pain Interferes with Activity or Movement, M1830 Bathing and M1850 Transferring
clarification on staging closed pressure ulcers that re-open
clarifying guidance related to M2030, Management of Injectable Medications and
M2250 Plan of Care Synopsis, guidance that changes existing language published in Chapter 3 of the 12/12 OASIS-C Guidance manual.
Missed the call? Order a CD of the April 17th Quarterly OASIS Update Teleconference to hear our experts discuss the latest CMS Q&As. The call handouts include unique application scenarios to test your retention from the changes covered as well as guidance resources created specifically for this teleconference by OASIS Answers.
Linda Krulish, PT MHS COS-C President, OASIS Answers Inc.
The 2013 edition of everyone’s favorite “Little Brown Book” is in! All prepublication orders for INSTANT OASIS Answers 2013 have been shipped.
A little info on our new baby…
How many changes are there from the 2012 edition?.........
This Many :)
Update of Response-Specific instructions and/or Data Source content for 16 OASIS items
Addition of 53 new Quarterly Q&As
Replacement of 47 CMS Q&As with new CMS approved edits/updates
Removal of 3 Q&As that CMS retired since the last INSTANT edition
Replacement of the old Chapter 3 guidance with the newly released updates
Inclusion of the "Instant Purple Pocket" on the back cover, to accomodate the specially sized 2013 Quarterly Q&As "Purple Pocket Pages" (available for free at the OASIS Answers website).
Inclusion of OASIS Data use symbols for "Outcomes", "Potentially Avoidable Events", "Process Measures" and "Risk Adjustment"
Enhanced PPS notations not only identify which OASIS items contribute to payment, but also the thresholds (by response option) at which the degree of potential payment impact changes. (Additional explanations of these enhancements are outlined in the book's preface)
New design shading helps users more readily identify the actual OASIS items from the supporting guidance.
AND....users continue to have the option to choose their favorite book binding method:
Choose between the easy open, page-flippin' "Spiral/Coil Binding"
(preferred by office clinicians for desk use)
and the compact, durable lay-flat "Perfect Binding"
(favored by field clinicians for easy carrying and bag access)
Both bindings have a wrap around front cover to serve as a page-holder or to protect the book pages during transport.
The front inside cover also includes our 2013 Schedule for OAI-sponsored OASIS, Coding workshops and teleconferences. We hope you'll join us :)
Whether you are using it for in-home data collection, for auditing, education as a reference during the open-book COS-C Exam, or just for a little "light" late-night reading, we hope you enjoy your new INSTANT resource!
This quarterly update contains 16 new Q&AS containing the latest OASIS-C guidance from CMS, including instruction related to:
compliance issues with medical record software products that select OASIS responses
compliance with ROC timing when outpatient observation stays occur directly AFTER inpatient admissions
selecting a response to M1040 when a patient's outcome episode overlaps more than one flu season
selecting a response for availability of assistance for patients attending adult day care
changed guidance related to M1300 when both clinical factors and standardized pressure ulcer assessment tools are used
selecting a response when findings resulting from a multi-factor fall risk assessment and single factor standardized assessment don't match, and
critical guidance on when/how to report best practice actions provided before the SOC date, and/or before the Comprehensive Assessment is completed
Missed the call? Order a CD of the January 16th Quarterly OASIS Update Teleconference to
not only hear our experts discuss the latest CMS Q&As but also the changes in the new OASIS-C Guidance Manual - Chapter 3, updated at the end of December 2012. The call handouts include unique application scenarios
to test your retention from the changes covered as well as guidance resources created specifically for this teleconference by OASIS Answers.
The December 2012 Q&A Update has been completed including a review of all existing CMS OASIS-C Q&As located in Categories 1, 2, 3, and 4 of the master CMS OASIS Q&A data base. The update files were posted by CMS on 12/20/12 and are available for download:
Linda Krulish, PT MHS COS-C President, OASIS Answers, Inc.
Deborah Chisholm, RN BSN CPHQ COS-C Director of Educational Programs, OASIS Answers, Inc.
The Home Health Quality Improvement (HHQI) National Campaign reignited its efforts this fall to help home care providers improve quality with new evidence-based educational tools, individualized data reports and a variety of networking opportunities for home health and cross-setting providers. OASIS Answers’ President, Linda Krulish, and OAI’s Director of Educational Programs, Debbie Chisholm serve on the HHQI National Campaign’s Stakeholder Work Committee to assist in development and review of resources intended to assist home health agencies’ quality improvement efforts.
The first Focused Best Practice Intervention Package (BPIP), “Focus on Patient Self-Management”, will be released November 1st, 2012.
If you participated in the HHQI campaign in the past, you will be pleased to know that the new BPIPs are shorter and more to-the-point. Each one is a succinct intervention package designed to support or enhance your efforts on a best practice to reduce hospitalizations.
The Introduction to the Focus on Patient Self-Management BPIP explains, “All chronic care patients self-manage, but health care professionals have an opportunity to advance patient self-management through self-management support. Self-management support is the care and encouragement provided to people with chronic conditions and their families to help them understand their central role in managing their illness, make informed decisions about care, and engage in healthy behaviors (Improving Chronic Care).”
By Linda Krulish, PT, MHS, COS-C President, OASIS Answers, Inc.
The Missouri Alliance for Home Care's (MAHC) Fall Risk Assessment tool has undergone preliminary validation. An online article published on September 6, 2012 in Home Health Care Management & Practice reports that the tool is valid in identifying fall risk in home care patients. In a Press Releaseposted October 9, 2012, MAHC reports "Home health agencies will now be able to meet the OASIS requirements utilizing the MAHC-10 as an initial screen for fall risk… This single tool can be used with all patients, including bed-bound patients and those with severe mobility limitations, thereby meeting CMS criteria to mark a 'yes' response on M1910." Agencies may use the MAHC-10 toolat no cost, but are encouraged to consider participating in MAHC's eight-year-old Fall Prevention Benchmarking Project, which is detailed at www.homecaremissouri.org.
OASIS Answers' Associate Consultant, Dr. Wendy Anemaet, PT, PhD, COS-C will be joining us at the upcoming COS-C Conferencein Baltimore next month, for a special session to report on the current status of fall risk assessments, including the MAHC-10, and the associated impact to OASIS data collectors.
Part 1: Sparkle Sparks, PT MPT COS-C Senior Associate Consultant, OASIS Answers, Inc.
AHIMA Approved ICD-10-CM Coding Instructor
Last week, CMS confirmed through final rule publication that the implementation date for ICD-10 has officially changed to October 1, 2014. We all know that codes (currently of the ICD-9 variety) are a required part of our medical documentation. Many of us participate in one way or another in deciding which codes go where. But what do they really mean and how careful should we be in selecting them? When you consider what they’re used for the answer can be stunning.
First and foremost these numbers become part of our patients’ medical records – and they follow them for the rest of their lives. Remember, “First do no harm.” This applies to our documentation as well as our clinical interventions. None of us would intentionally harm our patients yet it seems as though some of us who choose these codes have no idea the damage that we can do when we assign codes erroneously. A classic example is assigning psychiatric codes from the mental disorders chapter based on observations reported on the OASIS or medications that we list on the 485. The rules that govern the completion of an OASIS are not the same as the coding guidelines. For the rest of Sparkle's article, please click here.
Part 2: Annette Lee, RN MS COS-C HCS-D Senior Associate Consultant, OASIS Answers, Inc.
AHIMA Approved ICD-10-CM Coding Instructor
Sparkle provided us with a great baseline in why coding is important. I come from a background of working for the Medicare Intermediary- so payment is on my mind. Is coding still at the core of reimbursement? Does it really have that much impact? Short answer: “ Yes”. So much so, that the OIG addressed coding again in the March 2012 report. The report noted that in 2008, the records reviewed by the OIG found that home health agencies up-coded (i.e., billed at a level higher than warranted) about 10 percent ($278 million) of claims. This is a big concern to the government, home health providers, and all of us as taxpayers. The report went onto say that home health agencies down-coded (i.e., billed at a level lower than warranted) about 10 percent ($184 million) of claims. Can we as an industry afford to not have appropriate payment, to the tune of $184 million dollars? The short answer, “No!”
Coding has been a part of the case-mix, PPS system since its inception. It has changed (can you say HIPAA?), expanded (Refinement of 2010) and recently contracted (deletion of hypertension codes in 2012) over the years. We are still all working on getting it right, as CMS provides us with additional guidance. For the rest of Annette's article, please click here.
Join us this fall for another COS-C Conference in Baltimore! The three-day event is similar to the OCCB's Annual Conference held in previous years, but with a more content heavy first day seminar. And as always, a continuation of our special COS-C Exam prep classes designed to ready you for the exam on the final day.
Registration is open for this three day Conference, featuring the expert OASIS Answers' team sharing the latest OASIS, Process Measure and ICD-9/10 Coding guidance.
During the conference we will highlight the achievement of the COS-C, the impact of the certification and provide three specialized review sessions for those individuals seeking to attain this nationally standardized designation. These sessions combined with the two-day Blueprint for OASIS Accuracy course, will form the most comprehensive and hands-on COS-C exam preparation found anywhere (exam held 11/15).
- 2-Day Blueprint for OASIS Accuracy Course
- Process Measures: It's a Game of Chutes and Ladders
- Coding Rocks! - A special Coding Update
- 3 one-time only COS-C Exam Prep Sessions - The most thorough COS-C Exam prep this year!
By Sparkle Sparks, PT, MPT, COS-C AHIMA Approved ICD-10-CM Coding Instructor Senior Associate Consultant, OASIS Answers, Inc.
Following the continuing saga of the implementation of ICD-10 is like playing a game of “red light, green light.” Remember that? Someone yelled “green light” and frantic motion was set in high gear. Then someone yelled “red light” and you had to freeze, no matter how uncomfortable and hard to maintain your position was. If you inadvertently moved, you were out of the game.
Many people aren’t aware that the 2013 target date was actually pushed back from 2011. Now it appears that the target has, once again, been proposed to be postponed to October 2014.
We were first alerted to this latest possible delay back on February 16th of this year. Health & Human Services’ Secretary Kathleen Sebelius announced that, “HHS will initiate a process to postpone the compliance date by which certain health entities have to comply with ICD-10.” This pronouncement created a few questions like, “what does process to postpone mean?” and, “certain entities – which ones are these?”
While we patiently awaited the answers to these questions another announcement was released on April 9, 2012. This time Kathleen Sebelius announced a proposed rule that would delay the compliance date for ICD-10 from October 1, 2013 to October 1, 2014. And while it is anticipated that the final rule would be announced this month, as of today the silence is deafening.
So while we wait for further direction what, if anything, should we be doing? The advice from one of the Cooperating Parties in charge of both ICD-9 and ICD-10, the American Health Information Management Association (AHIMA), “urged the healthcare industry to remain vigilant in their ICD-10 transition efforts despite an implementation delay.”
In the June issue of the “Journal of AHIMA” it was noted that while some timetables might need to be adjusted, the proposed delay should not be used as an excuse to procrastinate. AHIMA pointed out that even HHS is encouraging providers to continue on with the implementation schedules that they already have in place. There are some tasks that need to be completed anyway. Nothing is to be gained by waiting until the last minute. So agencies need to keep marching forward with organizational changes. But what should coders be doing at this point?
This same article discussed academia’s handling of coding curricula. According to AHIMA most facilities plan to offer multi-code set (both ICD-9 & ICD-10) training until the year before the new implementation deadline. At that point they will switch to teaching only ICD-10. What can we take away from this? Coders still need to remain vigilant & educated regarding ICD-9. Waiting until about a year prior to implementation to actually learn how to assign ICD-10 codes is another good idea. This practice is consistent with an observation that CMS made in a Medlearn Matters article last year. It stated that while it is not too soon to become familiar with the organization and structure of the ICD-10 code set, new features of the system and how the codes look; it is too early to actually learn how to assign ICD-10 codes.
It should be noted that the delay in ICD-10 has not affected the deadline for providers to comply with Version 5010. Version 5010 refers to the standards that HIPAA-covered entities must use when electronically conducting certain health care administrative transactions, such as claims, remittance, eligibility, and claims status requests and responses. To be compliant organizations must use Version 5010 to send and receive claims and all other HIPAA-adopted electronic transactions starting January 1, 2012; however, CMS has implemented an enforcement discretion period, which ended June 30, 2012.
Interested in ICD-9 & ICD-10 Coding Training? Join us this October in Dallas for an extensive update. Click here to learn more!