HCS-D Questions with Complete Solutions
When is a new OASIS completed? At the SOC, resumption of care, recertification every
60 days, with an unanticipated change in condition-either an improvement or a decline, transfer
into a facility, and at discharge from an agency
Five case-mix variables 1. Admission source
2. Timing
3. Clinical Grouping
4. Functional impairment
5. Comorbidity adjustment
Admission source 1. Institutional sources; hospitals, skilled nursing facilities, inpatient
rehab, long-term acute care hospitals, and inpatient psych facilities
* patient must have been in the facility within 14 days prior to admission to be an institutional
source
2. Community admission; emergency room visits, observation units, wound care centers, assisted
living facilities, and physician's office
,* Each 30-day payment episode is separate
* The patient must have had readmission to an acute care hospital within 14 days of the next 30-
day payment period to receive the institutional source for the subsequent 30-day episode
Timing The patient will fall into an early timing or late timing
* Early timing will be given to a claim that has not has a previous home health claim under the
Medicare home health benefit within the last 60 days.
* Early timing is only applicable to the first 30-day payment period
Clinical grouping Assignment of the primary diagnosis code determines the principal
grouping
Clinical groups 1. Neuro rehab
2. musculoskeletal rehab
3. Complex nursing
4. Wounds
5. Behavioral health
6. Medication management teaching and assessment
7. Surgical aftercare
,8. MMTA cardiac
9. MMTA endocrine
10. MMTA GI/GU
11. MMTA infectious disease
12. MMTA respiratory
13. MMTA other
Functional impairment level Based on OASIS responses;
M1033- patient characteristics for risk of hospitalization
M1800- Grooming
M1810- Upper body dressing
M1820- Lower body dressing
M1830- Bathing
M1840- Toilet transferring
M1850- Transferring
M1860- Ambulation
*Low, medium, high functional limitations
, Comorbidity adjustment 1.Based on up to an additional 24 secondary diagnoses reported
on the claim. Depending on the secondary codes reported, the payment can receive no
comorbidity adjustment, a low comorbidity adjustment, or a high comorbidity adjustment
2. 2021, Medicare implemented the no-pay RAP rule. An agency will need to complete the SOC
visit, and within 5 calendar days, the agency will need to submit a request for (a no pay)
anticipated payment (RAP). This must be filed AND accepted with the Medicare Administrative
contractor within 5 days or the agency will receive a penalty of 1/30 of the HHRG for each day
that the filing was late, beginning with the SOC visit.
3. The agency can submit 2 30 day episode RAPs at the same time, but each 30 day episode must
be submitted within the 5 day timeframe
Error correction An error or audit and the POC has already been submitted, an order to
correct the diagnoses or a new POC will need to be submitted.
* 2021 the RAP and final claim will not be connected to the coding or OASIS, and will be sent
for placeholders. The final claim will have the correct ICD-10 codes on it for submission to the
MAC for payment.
Resolved diagnoses HIPAA mandates that only unresolved diagnoses be reported. The
primary and secondary diagnoses are entered onto the billing claim. Therefore, resolved
conditions cannot be reported on the OASIS, POC or the billing claim.
When is a new OASIS completed? At the SOC, resumption of care, recertification every
60 days, with an unanticipated change in condition-either an improvement or a decline, transfer
into a facility, and at discharge from an agency
Five case-mix variables 1. Admission source
2. Timing
3. Clinical Grouping
4. Functional impairment
5. Comorbidity adjustment
Admission source 1. Institutional sources; hospitals, skilled nursing facilities, inpatient
rehab, long-term acute care hospitals, and inpatient psych facilities
* patient must have been in the facility within 14 days prior to admission to be an institutional
source
2. Community admission; emergency room visits, observation units, wound care centers, assisted
living facilities, and physician's office
,* Each 30-day payment episode is separate
* The patient must have had readmission to an acute care hospital within 14 days of the next 30-
day payment period to receive the institutional source for the subsequent 30-day episode
Timing The patient will fall into an early timing or late timing
* Early timing will be given to a claim that has not has a previous home health claim under the
Medicare home health benefit within the last 60 days.
* Early timing is only applicable to the first 30-day payment period
Clinical grouping Assignment of the primary diagnosis code determines the principal
grouping
Clinical groups 1. Neuro rehab
2. musculoskeletal rehab
3. Complex nursing
4. Wounds
5. Behavioral health
6. Medication management teaching and assessment
7. Surgical aftercare
,8. MMTA cardiac
9. MMTA endocrine
10. MMTA GI/GU
11. MMTA infectious disease
12. MMTA respiratory
13. MMTA other
Functional impairment level Based on OASIS responses;
M1033- patient characteristics for risk of hospitalization
M1800- Grooming
M1810- Upper body dressing
M1820- Lower body dressing
M1830- Bathing
M1840- Toilet transferring
M1850- Transferring
M1860- Ambulation
*Low, medium, high functional limitations
, Comorbidity adjustment 1.Based on up to an additional 24 secondary diagnoses reported
on the claim. Depending on the secondary codes reported, the payment can receive no
comorbidity adjustment, a low comorbidity adjustment, or a high comorbidity adjustment
2. 2021, Medicare implemented the no-pay RAP rule. An agency will need to complete the SOC
visit, and within 5 calendar days, the agency will need to submit a request for (a no pay)
anticipated payment (RAP). This must be filed AND accepted with the Medicare Administrative
contractor within 5 days or the agency will receive a penalty of 1/30 of the HHRG for each day
that the filing was late, beginning with the SOC visit.
3. The agency can submit 2 30 day episode RAPs at the same time, but each 30 day episode must
be submitted within the 5 day timeframe
Error correction An error or audit and the POC has already been submitted, an order to
correct the diagnoses or a new POC will need to be submitted.
* 2021 the RAP and final claim will not be connected to the coding or OASIS, and will be sent
for placeholders. The final claim will have the correct ICD-10 codes on it for submission to the
MAC for payment.
Resolved diagnoses HIPAA mandates that only unresolved diagnoses be reported. The
primary and secondary diagnoses are entered onto the billing claim. Therefore, resolved
conditions cannot be reported on the OASIS, POC or the billing claim.
