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COS-C Exam
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COS-C Exam

Exam Preparation

Exam Description

bullet 2.5 hour examination
bullet 100 multiple choice questions
bullet Examination content is based on the most current rules and guidance provided by CMS. (Visit our Resources page)
bullet Scores are based upon the number of questions answered correctly.

General Guidance

bullet Arrive at least 45 minutes prior the exam time to ensure you are not rushed.
bullet You must show two forms of identification during exam sign-in. One must be a picture ID.
bullet Candidates are allowed to bring beverages into the testing environment however they do so at their own risk; if there is a spill you will not be given any additional time. Food is not allowed in the exam room. 
bullet No electronic equipment of any kind may be used in or out of the exam room while the exam is being administered. Cell phones must be turned off to eliminate any potential distractions.
bullet Independent study of the current rules and guidance provided by CMS is encouraged for all exam candidates though is not explicitly required. 
    bulletThe Blueprint for OASIS Accuracy Course handout is a great resource to use for review and during the exam. Please understand however that the handout is updated monthly with the most current CMS guidance. An older copy of the handout may not include the latest guidance.
    bulletUse the domain descriptions below as a guide of any review and test yourself with the sample questions included. 
bullet The COS-C exam passing rate in 2016 was 73%. Passing rate is defined as the percentage of candidates who achieved a successful passing score during a specified time frame (i.e., during calendar year 2016, 73 out of every 100 COS-C testing candidates achieved the passing score).

Description of COS-C Exam Domains with Sample Questions and Study Resources

Time Points Domain

Description: The Time Points Domain tests your knowledge of situations and events which trigger mandatory OASIS data collection. You will need to understand when Start of Care, Resumption of Care, Recertification, Other Follow-up, Transfer, Death at Home and Discharge data is required to be collected. A good understanding of Time Points means that you must be able to not only identify specific situations when OASIS data must be collected, but also be able to discern when OASIS data collection would not be required. You could be presented with scenarios that include information such as the patient's age, payer, discharging facility, services ordered, events occurring during or following the clinician's visit and questioned about which OASIS data would be required.

Study Focus:
OASIS Guidance Manual, Chapter 3, M0100
CMS OASIS Q&As included in Category 2, 3 and the M0100 Category 4b Q&As
CMS OASIS Assessment Reference Sheet
OASIS Considerations for Medicare PPS Patients

Sample Question:

Question: On a routine revisit, your patient tells you that since the last time you visited she has had a three-day in-patient hospital stay to treat an exacerbation of COPD and now has several new medications which she doesn't know how to take properly. Select the response that reflects the OASIS data collection required by the scenario described.

a. No OASIS data collection is required
b. RFA 5 Other Follow-up assessment
c. RFA 6 Transfer to an inpatient facility-patient not discharged from agency, and RFA 3 Resumption of Care assessments
d. RFA 4 Recertification assessments

Correct Response (c)

Patient Populations Domain

Description: The Patient Populations Domain tests your knowledge regarding which patients require OASIS data collection. You could be presented with a scenario that describes a patient's payer, age, services ordered, and be required to apply the CMS guidance to determine if OASIS data collection is or is not required, based on the information provided.

Study Focus:
OASIS Guidance Manual, Chapter 3, M0150
CMS OASIS Q&As, Category 1
Comprehensive Assessment Requirements for Medicare-Approved HHAs

Sample Question:

Question: Which of the following patients requires OASIS data collection?

a. A 78-year-old patient with a primary diagnosis of Heart Failure admitted to the Hospice Medicare benefit.
b. A 17-year-old victim of a gunshot who requires daily packing of a wound; Medicaid is the payer.
c. A 47-year-old patient who qualifies for Medicare disability insurance and requires diabetic teaching and drug monitoring.
d. A 31-year-old patient with a wound infection that is status-post Cesarean section.

Correct Response: (c)

Regulations Domain

Description: The Regulations Domain tests your knowledge of the OASIS CMS Regulations regarding OASIS data collection. Specifically, you will need to have a good working knowledge of the Condition of Participation, Section 484.55, The Comprehensive Assessment of Patients; including each of the five Standards: Initial assessment visit, Comprehensive assessment, Drug regimen review, Update of the comprehensive assessment and Incorporation of OASIS data items.

Study Focus:
Condition of Participation, 484.55, Comprehensive Assessment of Patients
CMS OASIS Q&As, Category 2 and Category 4b, M0080 Q&As

Sample Question:

Question: The Conditions of Participation require that a drug regimen review be performed as part of:

a. Every comprehensive assessment
b. The Start of Care comprehensive assessment only
c. The Start of Care, Resumption of Care and Discharge comprehensive assessments only
d. The Start of Care, Resumption of Care, Recertification, and Discharge assessments only

Correct Response: (a)

Item-by-Item Guidance Domain

Description: The Item-by-Item Guidance Domain tests your mastery of OASIS item-specific guidance and scoring conventions for the various content areas of the OASIS data set: Demographics, Sensory Status & Wounds, Respiratory, Elimination & Neurobehavioral Status, ADLs & IADLs, Medication, Equipment, Therapy & Care Management, and Emergent Care, Inpatient Admission, Intervention Synopsis and Discharge. You will need to understand the intent of each OASIS item and have a working familiarity with all the special rules included in the Response-Specific Instructions for each item in Chapter 3 of the OASIS-C Guidance Manual and with related CMS Q&As. You may be presented with a question that is testing your knowledge of a fact regarding an M item. Alternatively, you may be presented with a scenario, and asked to determine which response option should be selected for a particular OASIS item, based on the details provided in the Exam scenario. The Exam scenario will provide you all the details needed to successfully apply the CMS guidance and select the single correct response. The Exam is open book, so as time allows, you will be able to consult your references as needed.

Study Focus:
OASIS Guidance Manual, Chapter 1, Conventions
OASIS Guidance Manual, Chapter 3, Item Guidance
CMS OASIS Q&As, Category 4b

Item-by-Item Content Area 1: Clinical Record Items, Patient History and Diagnoses & Living Arrangements     M0010-M1100

Sample Question:

Your patient had orthopedic surgery on her right hip on January 5th. After postoperative complications, she was discharged from the hospital to a rehabilitation facility on January 11th for therapy. She was discharged from the facility on January 19th. You are conducting the Start of Care assessment for an episode with a January 20th SOC date.

The correct response(s) to M1000, Inpatient Facility Discharges during the past 14 days, would be:

a. 3 - Short-stay acute hospital
b. 5 - Inpatient rehabilitation hospital or unit (IRF)
c. 3 - Short-stay acute hospital and 5–Inpatient rehabilitation hospital or unit (IRF)
d. NA - Patient was not discharged from an inpatient facility

Correct Response: (c)

Item-by-Item Content Area 2: Sensory Status & Wounds M1200-M1350

Sample Question:

Question:  At the Start of Care, your patient has a Stage 1 pressure ulcer on his right elbow, a Stage 2 pressure ulcer on his left elbow and a Stage 4 pressure ulcer on his left hip that closed 4 years ago.

Select the answer that contains the best responses for M1311 at the SOC assessment:

   (M1311) Current Number of Unhealed Pressure Ulcers at Each Stage Enter Number
 A1 Stage 2: Partial thickness loss of dermis presenting as a shallow open ulcer with red pink wound bed, without slough. May also present as an intact or open/ruptured blister.
Number of Stage 2 pressure ulcers
 B1 Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.
Number of Stage 3 pressure ulcers
C1 Stage 4: Full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling.
Number of Stage 4 pressure ulcers
 D1 Unstageable: Non-removable dressing: Known but not stageable due to non-removable dressing/device
Number of unstageable pressure ulcers due to non-removable dressing/device
 E1 Unstageable: Slough and/or eschar: Known but not stageable due to coverage of wound bed by slough and/or eschar
Number of unstageable pressure ulcers due to non-removable slough and/or eschar
 F1 Unstageable: Deep tissue injury: Suspected deep tissue injury in evolution
Number of unstageable pressure ulcers with suspected deep tissue injury in evolution

a. A1 = 1,  B1 = 0,  C1 = 0,  D1 = 0,  E1 = 0,  F1 = 0
b. A1 = 1,  B1 = 0,  C1 = 1,  D1 = 0,  E1 = 0,  F1 = 0
c. A1 = 0,  B1 = 0,  C1 = 1,  D1 = 0,  E1 = 0,  F1 = 1
d. A1 = 1,  B1 = 1,  C1 = 0,  D1 = 0,  E1 = 0,  F1 = 0

Correct Response: (a)

Item-by-Item Content Area 3: Respiratory, Cardiac, Elimination & Neuro/Behavioral M1400-M1750

Sample Question:

Question: Your patient requires intermittent catheterization to relieve urinary retention and also experiences stress incontinence when sneezing. The best response for M1610, Urinary Incontinence or Urinary Catheter Presence would be:

a. 1 - Patient is incontinent and 2 - Patient requires a urinary catheter
b. 0 - No incontinence or catheter (includes anuria or ostomy for urinary drainage)
c. 1 - Patient is incontinent only
d. 2 - Patient requires a urinary catheter (i.e. external, indwelling, intermittent, suprapubic) only

Correct Response: (d)

Item-by-Item Content Area 4: ADLs/IADLs M1800-M1910

Sample Question:

Question: Your patient had abdominal surgery last week and now has an open wound which requires daily dressing changes. You are completing your comprehensive assessment and note that she is wearing a housedress with slippers and no socks. She tells you that she hasn't tried to put on her regular clothes (which she describes as her underwear, pants, shoes and socks) because she is "afraid something will break" referencing her open wound if she bends too much. You ask her if she would try to dress while you are there with her and she demonstrates that she is too afraid and uncomfortable for the mobility required to dress her lower body. The patient usually wears pants, underwear, socks, and shoes with orthotic inserts.

The correct response for M1820, Ability to Dress Lower Body, would be:
a. 1 - Able to dress lower body without assistance if clothing and shoes are laid out or handed to the patient.
b. 2 - Someone must help the patient put on undergarments, slacks, socks or nylons and shoes.
c. 3 - Patient depends entirely upon another person to dress lower body
d. UK – Unknown

Correct Response: (c)

Item-by-Item Content Area 5: Medications and Care Management    M2001-M2110

Sample Question:

Question: On Tuesday, the Start of Care date, in order to complete the drug regimen review, the physical therapist provided the RN in the office with a list of all medications the patient was taking, the patient's physical and cognitive status and details regarding the patient's stated noncompliance with her prescribed oral antibiotic regimen which the therapist thought was a significant medication issue. The nurse finished the drug regimen review and called the report of the patient to the physician’s office.  The physician’s office called the home health agency office nurse back on Wednesday with an appointment for the patient to be seen on Thursday. The agency nurse communicated the appointment to the patient immediately after speaking with the physician on Wednesday and also called the therapist to inform her of the physician’s response to the medication issue.  The therapist used the information to complete the SOC assessment.

Based on this scenario, how would M2001 Drug Regimen Review and M2003 Medication Follow-up be answered on the Start of Care assessment?

a. M2001 = 0 – No. No issues found during review; M2003 = skipped
b. M2001 = 1 – Yes.  Issues found during review; M2003 = 0 – No follow up or 
completed interventions by midnight of the next calendar day.
c. M2001 = 1 – Yes. Issues found during review; M2003 = 1 – Yes – Follow up and interventions completed by midnight of the next calendar day.
d. M2001= 9 – NA. Patient not taking any medications; M2003 = Skipped

Correct Response: (c)

Item-by-Item Content Area 6: Therapy Need and Plan of Care, Emergent Care, Inpatient Admission or Agency Discharge Items   M2200-M2430, M0903-M0906

Sample Question:

Question: A record review indicated that Mrs. Black was admitted to the home health agency on August 30.  Two weeks later she was seen in the ER for chest pain and released after treatment with a GI cocktail.  Mrs. Black is in her second certification period and the nurse made a prn visit after receiving a call that the patient's port-a-cath, used for chemotherapy, was oozing blood. After assessing the patient who also had complaints of weakness and nausea, the nurse placed a call to the physician who arranged for the patient to be directly admitted to a hospital bed where the patient remained as an inpatient for two days.

When completing the Transfer to Inpatient OASIS assessment, the correct response(s) for M2301, Emergent Care, would be:

a. 0 – No
b. 1 – Yes, used hospital emergency department WITHOUT hospital admission
c. 2 – Yes, used hospital emergency department WITH hospital admission
d. UK – Unknown

Correct Response: (b)

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