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Identifying OASIS Requirements for One Visit Episodes

• Ann Giles


One Visit Episodes

We often receive questions regarding situations where only one visit is necessary for a patient. Questions such as: Is the OASIS required? If the OASIS is required, do I need to submit it? Can I bill for a single visit in a quality episode? We must turn to the official guidance to answer all of these questions and others. Q&A 21 in category 4b outlines the regulations regarding one visit episodes. Let’s take a look at what this guidance says.

Guidance

Based on CMS policy, when only one visit is made in a quality episode (SOC/ROC to TRF/DC), OASIS data collection and submission is not required. OASIS data must, however, be collected and submitted if an agency plans to bill for the visit. A HIPPS code is necessary in this case, so we must use the OASIS data to calculate that HIPPS code. When answering the OASIS, M0100 should indicate that this is a SOC assessment. But remember, if you will not bill for the visit, you will not need to collect OASIS data.

Let’s take this one step further. Let’s say you choose to collect the OASIS data and submit it for payment. The patient’s name will then show up on your agency roster in the data management system (DMS) and will remain on the roster for six months. It’s important to note that if the patient is readmitted during that six months, you will receive a warning that the new assessment is out of sequence. Despite receiving this message, you should be able to transfer this assessment.

If you have any OASIS questions, always remember to turn to your official guidance.

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Ann Giles, RN, BSN, HCS-D, COS-C

Director of Coding & OASIS Review

A native of La Place, LA, Ann joined PPS Plus after earning her degree from Louisiana State University. She contributes her expertise and nursing experience in developing the thousands of alerts within OASIS Analysis Plus. When not submerged in her coding, Ann loves to submerge herself in tropical waters for some scuba diving and spearfishing with her husband, Ryan.