The RFA 5 - Other Follow-up Assessment
Standard D of the Conditions of Participation outlines when the comprehensive assessment is to be updated. One of the time points mentioned in this standard is when the patient has a significant decline or improvement in condition. When the patient has a significant decline or improvement that was not foreseen on the original plan of care, an RFA 5, other follow up, assessment is necessary. Back in 2007, there was additional reimbursement associated with these assessments if warranted. Even though the potential payment was eliminated in 2008, the requirement of the Conditions of Participation remains.
CMS does not define what warrants a major decline or improvement. This must be defined in an agency policy. Furthermore, when an other follow up assessment is completed, keep in mind that the plan of care will mostly likely need to be updated. This is a comprehensive assessment, so it requires a home visit, and it must be completed within two days of identifying the major decline or improvement.
Another factor to keep in mind is that the other follow up assessment is not necessary if the major decline or improvement happens within the last five days of the certification period. If this is the case, the recert will capture the change in patient status.
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