WHAT HAS YOUR AGENCY DONE WITH THE CHANGES IN THE OASIS ONE CLINICIAN RULE?
AUGUST 16, 2018
According to CMS Q&A’s April 2018, Effective January 1, 2018, the assessing clinician may elicit input from the patient, caregivers, and other health care personnel, including the physician, the pharmacist and/or other agency staff to assist in completion of any or all OASIS items integrated within the comprehensive assessment document.
This change may require some changes in your agency’s processes and in some ways encourages the use of the 5 day window for OASIS collection.
Scenario 1: In a situation where the patient refuses to let the admitting nurse see his/her back in order to check for pressure ulcers because the patient was already up in a wheelchair, it is appropriate to have the next nurse who sees the patient within the next five days check for pressure ulcer/wounds and convey the information to the assessing clinician. In this case, M0090 should be dated the date of the second nurse’s visit when the information for the OASIS Integumentary section has been obtained.
This can benefit your agency financially because if the admitting clinician cannot document existing wounds at the first visit, you will be missing some crucial case mix and/or NRS points that could affect reimbursement. By collaborating with the second nurse within the five day window, the skin problems can be coded on the OASIS to capture those points.
Scenario 2: The aide who visited the patient on Monday, discovered the patient had been hospitalized for two days and discharged home on Sunday. The RN visits the patient on Tuesday to do the ROC assessment, the PT visits on Wednesday, and the OT visits the patient on Thursday. Based on the expanded collaboration allowed the nurse could use information from the aide and PT visits to complete ROC OASIS items as long as both visits were done within two calendar days of the agency knowledge of the patient’s return home. The OT visit on Thursday is outside the assessment timeframe and information from that visit may not be considered when determining OASIS responses. In this case, M0090 should be dated the date of the last visit that was within the two-day window, or the date of the PT visit.