period begins. The recertification assessment visit must be made on any day from Day 56 through Day 60 of the ending certification period, and the therapist must complete the Recert OASIS and a new POC by Day 60. Each 60-day episode is distinct and cannot overlap with another episode. Discharge The Discharge OASIS is performed by the last discipline – registered nurse, physical therapist, occupational therapist, or speech-language pathologist – providing care to a patient on the last visit to that patient. During the discharge visit, the clinician uses the Discharge OASIS to evaluate the patient’s status on the same outcome indicators against which the patient was evaluated at the admission visit. Other quality indicators are also captured, sometimes from the patient’s medical record, about “best practice” care processes that were employed in the patient’s care, and sometimes from indicators such as a patient’s need for emergency care during the certification period. The Discharge OASIS must be completed within 2 days of the discharge visit. A Discharge OASIS should typically be associated with a patient visit, but sometimes patients are lost to care before a planned discharge visit can be made. An unexpected discharge can occur, for example, when the patient refuses further visits, the patient is moved from one family member’s home to another, or the physician unexpectedly orders an end to home health services. These sorts of scenarios are unwelcome and possibly could have been avoided with better communication with the
patient, the patient’s family, and the physician. Once these situations occur, the CMS regulations stipulate that the last professional team member – registered nurse, physical therapist, occupational therapist, or speech- language pathologist – to have made a visit to the patient should complete a Discharge OASIS based on the clinician’s recall of the patient’s status at that visit. This situation is far from ideal, but even worse is when the patient has been seen only by paraprofessionals –licensed practical nurses, physical therapy assistants, or occupational therapy assistants – for a period of time. Even though the patient’s clinical and functional status may have significantly improved under their care, these improvements cannot be recorded on the OASIS assessment because CMS regulations require the clinician to base the OASIS data on the patient’s status at the last time a qualified clinician made a visit to the patient. This situation negatively affects agency outcomes. Data submission One of the primary reasons therapists perform OASIS assessments is to provide the CMS with the data needed to compare one agency’s performance with that of all other agencies. Thus, agencies are required to encode and transmit all Medicare and Medicaid patients’ OASIS data to the national Assessment Submission and Processing (ASAP) system within 30 days. To accomplish this goal, agencies enter each patient’s OASIS data into a computer software program that allows for retrieval and analysis of the information in a way that protects the confidentiality of each patient’s data. and home health aides to clarify functional assessment findings. Therapists combine all these sources of information and should then use their critical thinking skills and clinical judgment to evaluate and synthesize the information to determine the correct response to each item. Conventions and guidelines The CMS has published a manual – the OASIS-D Guidance Manual (CMS,2019) – that gives instructions on how to interpret and respond to the OASIS items. This manual provides a list of general instructions, the General OASIS Item Conventions (see Figure 1). Home health therapists should study and master this list of conventions, carefully observing them as they complete OASIS assessments. The OASIS-D Guidance Manual devotes its most important and longest chapter to providing guidance for each individual OASIS item. Chapter 3 of the manual is the “bible” for completing each of the 90 OASIS items accurately. It is not possible to complete an OASIS accurately without understanding and mastering the guidance for each item within the chapter. ● The OASIS Item : Is provided exactly as it appears on documentation forms. ● Item Intent : Explains the rationale for collecting the item and its importance for care planning, measuring patient outcomes and processes used in care, and outcome and prospective payment risk adjustment. ● Time Points Completed : Describes when the item is completed during the patient’s stay in home care, such as at start of care, transfer, resumption of care, recertification, or discharge. ● Response-Specific Instructions : Describe how the clinician should decide which of the possible responses to the item should be selected. These are detailed instructions about the nuances of the question and responses, including explicit directions concerning what information should be included and excluded in selecting the response, the interpretation of specific words or phrases included in the questions and responses, and other crucial information to keep in mind when completing the item.
How should a therapist determine the correct response to each OASIS question? Determining the correct response to each OASIS item requires knowledge and skill. The therapist needs to know how to assess the patient for OASIS purposes and needs to know the general conventions for completing an OASIS assessment and the guidelines for completing each specific item. The following sections consider each of these requirements in more detail. Assessing the patient
For many of the OASIS items, therapists should interview patients, caregivers, and family members about what they believe the responses to various items should be. If there is a discrepancy between the patients’ and family members’ reports, the therapist should use clinical judgment to determine who is the most reliable historian. However, therapists should also evaluate these reports with their own skilled observations about the patient’s status and with a review of any documentation that is available about the patient, such as hospital discharge summaries or history/physical records. Discussions with other healthcare providers may also be indicated, such as phone calls to the physician to verify diagnoses or discussions with therapists
CHAPTER 3: OASIS-D GUIDANCE MANUAL
The third chapter of the OASIS-D Guidance Manual is titled “OASIS Item Guidance.” It is an important resource that every therapist should have at hand. It can be found by searching OASIS-D Guidance Manual or at https://www.cms.gov/ Medicare/Quality-Initiatives-Patient-Assessment- Instruments/ HomeHealthQualityInits/Downloads/OASIS-D-Guidance-Manual- final.pdf The only part of this document that is needed is Chapter 3, OASIS Item Guidance. Many agencies make this document available to their clinicians electronically or in a print version. Some electronic documentation systems provide access to the guidance for each individual OASIS question by linking each OASIS question to its item-specific guidance within Chapter 3. Each of the 90 OASIS items has a dedicated page in Chapter 3 that provides in-depth guidance about the item. (Some items extend beyond a page to two or more pages because the guidance for the particular item is extensive.) The page for each item follows the same template and includes the following sections:
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Book Code: PTCA2622B
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