certain patient situations will challenge their ability to apply their remembrance of the guidance to a particular patient’s situation; they should always keep the Guidance Manual “at hand” and consult it frequently. Once therapists have mastered OASIS, they need to remember that OASIS is a tool for assessing the patient as well as a tool to determine reimbursement, measure quality, and document compliance. When therapists use it at admission or to resume Glossary ● Accountable care organization (ACO) : A group of healthcare providers who voluntarily work together to improve care coordination and improve quality outcomes; financial losses and gains are shared among the ACO participants. ● Accreditation : A voluntary process sought by healthcare organizations that demonstrates adherence to the highest standards of practice. ● Activities of daily living/instrumental activities of daily living (ADLs/IADLs) : Activities of daily living are fundamental activities needed to care for oneself, including bathing, grooming, dressing, toileting, ambulating, and eating. Instrumental activities of daily living are activities needed to live independently, such as preparing meals, doing laundry, housekeeping, buying groceries, getting to appointments (transportation), talking on the phone, and paying bills. ● Autonomy : An attribute of professional practice, autonomy relates to the authority to make decisions and the freedom to act in accordance with one’s professional knowledge base and is associated with accountability and responsibility. ● Best clinical practices : Standardized clinical strategies and interventions that, when applied consistently, result in desired, predictable patient outcomes. ● Bundled payment : Payment based on a specific medical condition, a set of linked services (e.g., acute care, home care outpatient), and a length of time; payment is shared among healthcare providers. ● Care coordination : The process of thoughtfully organizing patient care activities and sharing information among all participants involved in a patient’s care in order to achieve the safest, most effective, cost-efficient care possible. ● Case management : A process performed collaboratively with the patient that consists of assessing, planning, facilitating, coordinating care, evaluating, and advocating for the best options and services available to meet a patient’s comprehensive health needs as cost- efficiently as possible. ● Case mix : The system used by Medicare to establish payment for home care services; it is based on completion of the OASIS tool to establish clinical severity, functional severity, and service utilization factors. ● Centers for Medicare and Medicaid Services (CMS) : Formerly known as the Health Care Financing Administration; part of the U.S. Department of Health and Human Services that is responsible for regulating and administering the Medicare benefit. ● Code of Ethics : This section is part of each discipline’s Practice Act, to guide therapists in decision making, conduct, and practice. ● Conditions of Participation (CoPs) : The federal guidelines that give healthcare providers a detailed and extensive explanation of the minimum requirements to obtain and maintain Medicare certification. ● Durable medical equipment (DME) : Therapeutic equipment – such as hospital beds, walkers, wheelchairs, pumps, ventilators, and many other types of equipment – that can be used repeatedly. ● Episode : Under Medicare, the 60-day time period for which a lump sum payment is provided to an agency. ● Evidence-based practice : A problem-solving approach to clinical practice and administrative issues that integrates research, clinical expertise, and patient preferences and values. ● Homebound : Restricted ability to leave the home because of an illness or injury. The patient does not have to be bedridden, but leaving the home is infrequent, for short duration or for healthcare treatment, and takes a “considerable and taxing effort.” ● Home Health Compare : A website sponsored by the CMS that offers information about the quality of care provided by Medicare- certified home health agencies throughout the United States. ● Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) : A standardized, nationwide patient survey that Medicare and Medicaid patients are invited to complete concerning the quality of care they received from their home health agencies. ● Low utilization payment adjustment (LUPA) : An adjustment to the Medicare prospective payment system episode payment that is applied when a home health beneficiary receives fewer than five home visits.
care after a hospitalization, they need to keep in mind that when a patient’s OASIS data show that the patient has a deficit or issue, the deficit needs to be addressed in the POC the therapist develops for that patient. In other words, whenever OASIS data show that the patient has a deficit or issue in an area, the therapist needs to determine what strategies can be used to help the patient improve in order for the patient to reach optimal health and well-being. ● Medicare-certified agency : A home health agency that agrees to adhere to the Medicare CoPs for providing care to Medicare patients under their home health benefit. An agency must be Medicare certified to bill for the care provided to Medicare patients. ● Medicare home health benefit : The home health services to which Medicare patients are entitled. The benefit focuses on skilled intermittent services for homebound patients that promote recovery from illness or injury. ● Medicare hospice benefit : A blend of skilled and continuous services available to patients with terminal diagnoses that are governed by a different set of regulations from the home health benefit. ● Negative outcome : The result achieved when a patient declines in physical or functional status from start of care to discharge. ● Null outcome : The result when a patient’s status neither improves nor declines but rather remains stable when compared at two points in time. ● Outcome and Assessment Information Set (OASIS) : An instrument that must be completed for most Medicare and Medicaid patients at admission to and discharge from home health services and at various other time periods during a patient’s stay in home care. The OASIS instrument has been revised several times since its inception in 2000; the current version as of January 2017 is OASIS-C2. The instrument is used to measure quality processes and outcomes, to determine reimbursement, and to plan care. ● Paraprofessional : A person to whom particular aspects of professional tasks are delegated but who is not licensed to practice as a fully qualified professional. Home health paraprofessionals include licensed practical nurses, physical therapy assistants, occupational therapy assistants, and home health aides. ● Partial payment adjustment (PPA) : A proportional adjustment to the Medicare prospective payment system payment that is applied when the patient does not complete an episode of care as a result of a transfer to another agency or when a patient was discharged and then readmitted within the same episode. ● Patient-Driven Groupings Model (PDGM) : a case-mix methodology payment system consisting of 30-day payment periods. Relies on clinical characteristics and other patient information to place patient into categories. ● Personal care services : Unskilled care that does not require the skills of a nurse or therapist but helps patients with their ADLs. ● Positive outcome : The result achieved when the patient improves, for example, from a less functional status to a more functional status. ● Potentially Avoidable Event Report : A CMS-generated report derived from the analysis of an agency’s OASIS data. The report provides the agency with its incidence for each of the 13 undesirable patient outcomes. This report also provides a comparison of the agency’s incidence rate with the incidence rate of these events in other agencies throughout the nation. ● Prospective payment system (PPS) : The Medicare home healthcare reimbursement system whereby the CMS provides an agency with a lump sum payment based on a patient’s OASIS assessment via the PDGM. ● Quality assurance : The process that a home health agency uses to maintain the expected level of quality in its processes, services, and outcomes. ● Quality Episode : This is not the same as a 60 day billing episode. A Quality Episode (sometimes referred to as a Care Episode) consists of a Start of Care (SOC) or Resumption of Care (ROC) assessment and a matching End of Care (EOC) assessment. The EOC assessment may consist of either a Transfer OASIS or a Discharge OASIS. ● Quality improvement : A formal methodology to analyze performance and systematic efforts to improve it; sometimes referred to as “performance improvement.” ● Quality outcome : Measure of the change in a patient’s clinical and functional status between two points in time. The change in the patient’s status can be positive (improved), negative (declined), or null (unchanged). ● Rehabilitation therapist : Therapist who has met specific education and certification requirements to provide physical therapy, occupational therapy, or speech-language therapy services. ● Risk-Adjusted Outcome Report : A CMS-generated report that provides an agency with a summary of the agency’s performance
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Book Code: PTCA2622B
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