Self-Awareness Flashcards

In a "PT only" episode, when there are o orders for skilled nursing at the SOC, the visit made by the RN to perform an OASIS assessment is:

Answer: Not billable

In a 'PT only' episode with no skilled nursing orders at the start of care, an RN visit performed solely to complete the OASIS assessment is not billable as a skilled nursing visit. Medicare does not reimburse the assessment visit as a service when no skilled nursing care has been ordered for that episode. The visit is an administrative requirement, not a reimbursable skilled service.

Your home health patient has two insurance carriers. Her primary insurance carrier is Blue Cross Blue Shield, and her secondary payer is Medicare. How should you answer M0063 (Medicare number)?

Answer: Enter the Medicare number (HICN or MBI)

OASIS item M0063 asks for the patient's Medicare number regardless of whether Medicare is the primary or secondary payer. If the patient is a Medicare beneficiary, their HICN or MBI must be recorded because Medicare's data collection requirements apply to all beneficiaries receiving home health services. Using the Blue Cross number or marking 'NA' would be incorrect for an enrolled Medicare beneficiary.

Your home health patient has Medic Aid in addition to Medicare to help pay for home care services. How should you respond to M0065 (Medicaid number)?

Answer: Enter the Medicaid number

If a patient has Medicaid coverage, the Medicaid number must be entered in M0065, even when Medicare is also a payer. OASIS data collection requires accurate payer information for all applicable coverage, so leaving it blank or marking 'NA' would be incorrect for a patient with active Medicaid. Entering the Medicare number in a field designated for Medicaid would also be an error.

At which OASIS time point are you required to complete M0066 (Birth date), M0069 (Gender) and M0140 (Race/ethnicity)?

Answer: Start of care

Demographic items M0066 (birth date), M0069 (gender), and M0140 (race/ethnicity) are collected only at the start of care, when the initial comprehensive assessment establishes the patient's baseline record. These data points do not need to be re-collected at transfer or discharge time points because they remain constant throughout the episode.

Your patient was under care with a Medicare HMO for three episodes until Sept. 30th. The patient transferred to traditional Medicare, effective October 1st, and was admitted to your agency on October 2nd. How should the clinician answer M0110 (Episode timing)?

Answer: Early

When a patient transfers from a Medicare HMO to traditional Medicare, the prior HMO episodes do not count toward traditional Medicare episode timing. October 2nd is the patient's first admission under traditional Medicare, making this an "Early" episode (episodes 1 or 2). The HMO and traditional Medicare are separate benefit structures, so the episode clock resets entirely upon transfer.

On May 10th, a home health agency referral from a hospital discharge planner on behalf of the physician to start care for Mrs. Smith on May 12th. What date should be entered in M0102 (Date of physician-ordered start/resumption of care)?

Answer: May 12th

M0102 asks specifically for the date the physician ordered care to begin, which is May 12th — the start date specified by the referral. May 10th is when the referral was received, not when care was ordered to start. The item must be completed with the physician-ordered start date regardless of when the agency received the referral or when the physician directly confirms it.

When a patient is discharged from an inpatient facility and care is resumed within the last five days of the episode (i.e., a recertification assessment is due), which assessment should be completed?

Answer: ROC (RFA 3)

When a patient is discharged from an inpatient facility and returns to home health care, a Resumption of Care (ROC) assessment using RFA 3 is always required, regardless of where the patient is in their episode. Even if the ROC falls within the last five days when a recertification would normally be due, the ROC assessment takes precedence because resuming care after an inpatient stay is a distinct clinical event requiring its own assessment. A recertification assessment is not appropriate here because the patient was not continuously on service.

Your home health patient was admitted on March 4th and was on service for two weeks when his daughter called on March 18th to tell you that the patient died. The clinician completed the final assessment in the office on March 19th. What is the most appropriate response to M0090 (Date assessment completed)?

Answer: None of the above, the clinician has to visit the patient to complete the assessment

OASIS assessments must be completed through direct patient contact — the clinician must conduct a visit rather than completing paperwork remotely in an office. Because the clinician did not visit and completed the assessment in the office on March 19th without patient contact, none of the listed dates are valid. The proper procedure requires a home visit to gather the information needed to complete the assessment, even for discharge assessments.

Are social workers permitted to review and/or audit OASIS documents and provide guidance to the qualified/assessing physician?

Answer: Agency policy may define the qualifications of a person doing a quality review of a comprehensive assessment, OASIS items, and/or providing education or instruction related to OASIS data collection.

Federal regulations restrict who can complete OASIS assessments, but agency policy has latitude to define who may conduct quality reviews and provide education related to OASIS data collection. This means a social worker can audit OASIS documents and provide guidance without being a qualified OASIS assessor. The wrong options incorrectly conflate the ability to review/audit with the stricter requirement to collect and document OASIS assessments, and the last option incorrectly limits reviewers from providing instruction.

Except for the SOC assessment, which of the following disciplines is allowed to complete an OASIS assessment (M0080)?

Answer: Occupational therapist (OT)

Occupational therapists are among the qualified disciplines permitted to complete OASIS assessments for visits other than the Start of Care. LPNs and home health aides are not qualified to complete OASIS assessments at any time. Social workers, even with a Master's degree, are not permitted to complete OASIS assessments, as the regulations specify the disciplines that can do so.

You are conducting a SOC assessment and your patient is a member of Medicare HMO, how should you answer M0063 (Medicare number)?

Answer: Enter the Medicare number (HICN or MBI) if available

Even though the patient is enrolled in a Medicare HMO, they still have a traditional Medicare identification number (HICN or MBI) that should be recorded in M0063 if it is available. The Medicare HMO identification number is a plan-specific number and is not what this field requires. Leaving the field blank or entering a Social Security number would both be incorrect — the field specifically requests the Medicare beneficiary number.