OASIS and PDGM Exam Questions & Answers 2023-24

OASIS and PDGM Exam Questions & Answers 2023-24 patient driven groupings model (PDGM) - ANSWER-- Used in Home Health starting January 1, 2020 - 30-day periods as a basis for payment - Timing of the 30-day period (two subgroups): early or late - Clinical grouping (twelve subgroups) - Functional impairment level (three subgroups): low, medium, or high - Comorbidity adjustment (three subgroups): none, low, or high based on secondary diagnoses. - In total, there are 2*2*12*3*3 = 432 possible case-mix adjusted payment groups timing of PDGM - ANSWER-- First 30-day period is considered early. All subsequent 30-day periods are considered as late. A sequence of 30-day periods continues until there is a gap of at least 60 days - When there is a gap of at least 60-days, the subsequent 30-day period is classified as being the first 30-day period or early. - OASIS must be completed within 5 days of the SOC date and updated no less frequently than during the last five days of every 60 days beginning with the SOC. - Information obtained from the OASIS used in the PDGM may not change over the two 30-day periods the OASIS covers PDGM timing: significant change in condition - ANSWER-If a patient experiences a significant change in condition before the start of a subsequent, contiguous 30-day period, for example due to a fall; a follow-up assessment would be submitted at the start of a second 30-day period to reflect any changes in the patient's condition, including functional abilities, and the second 30-day claim would be grouped into its appropriate case-mix group accordingly admission source - ANSWER-- Two admission source categories - community or institutional - Depending on what healthcare setting was utilized in the 14 days prior to home health admission. - Late 30-day periods are always classified as a community admission unless there was an acute hospitalization in the 14 days prior to the late home health 30-day period.