Are functional assessment OASIS errors causing your agency to lose reimbursement?

March 17, 2015

Are functional assessment OASIS errors causing your agency to lose reimbursement?

Functional assessment OASIS items (M1800-M1890) are considered quality indicators. This means they contribute to risk adjustment of quality outcome scores in OASIS C1/ICD-9. Several of these items (M1810, M1820, M1830, M1850, and M1860) also contribute to the functional domain of the Home Health Resource Group (HHRG), which includes case-mix points.

Functional OASIS items identify the patient’s safe ability to perform activities of daily living (ADLs), including basic self-care activities such as bathing, dressing and toileting. These items also identify instrumental activities of daily living (IADLs), which include activities associated with the patient’s independent living that are necessary to support the ADLs, such as telephone use and meal planning and preparation. It is sometimes difficult for clinicians to respond to these M-items because many clinicians score patients based on what the patient is able to do.

In the OASIS Guidance Manual, the Chapter 3 Instructions outline the item intent for each of the functional items. The instructions indicate the item is intended to identify the patient’s ability to safely perform the activity, given their current physical and mental/emotional/cognitive status, activities permitted, and their environment. The items do not necessarily identify the patient’s actual performance. It is important to remember that willingness and adherence are not the focus of the items.

If a patient’s physical ability has been impeded, for even a short time, and the patient requires the use of an assistive device or needs someone to be present in the room to ensure they remain safe and steady throughout the activity, this indicates the patient needs assistance to safely perform the activity and it should be marked appropriately on the OASIS.

For instance, M1840 – Toilet Transferring, includes the patient’s ability to get to and from the toilet or bedside commode safely AND transfer onto and off of the toilet/commode. If the patient has had a recent surgical procedure and they are unsteady to the point where they require someone present in the room, even if the assistant does not have to physically touch the patient, the appropriate response is “1 – when reminded, assisted, or supervised by another person, able to get to and from the toilet and transfer.”

It is extremely important to understand what the OASIS data items are asking before selecting a response. If you are unsure, always refer to the OASIS Guidance Manual for additional information.

You may view the manual at CMS’ website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIOASISUserManual.html

If you would like to download the Official Oasis Guidance Manual, please click: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/OASIS-C1-ICD-9-Guidance-Manual.zip

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