Download Test answers

Test answers
Understanding Case Mix
1.
What is case-mix adjustment?
It is an algorithm that predicts the total resources expected to be required to care for the patient.
Payment is based on the patient’s anticipated care needs based upon the case mix number assigned to him
or her.
2. What are the domains of the case-mix model? What are the indicators of clinical needs (data elements)
for each domain?
Clinical severity: patient history, sensory, integument, respiratory, elimination neuro, emotional and
behavioral stauts MO 230, 240, 250, 390 420, 440, 450, 460, 476, 488, 490, 530, 540, 610
functional status: ADL’s and IADL’s—mo 650, 660, 670, 680, 690, 700
service utilization: Use of inpatient services preceding admission, estimated number of visits planned
MO175—line 1 175 line 2, 175 line 3 MO825
3. The point values for the OASIS items within each of the three domains are___summed_____________
to determine_a patient’s point score in each domain_____________________________________
4. How many severity levels are there for each domain?
Clinical severity = 4 functional = 5 Service = 4
5. If a patient’s domain score in the clinical domain was 20, what would be the code for his domain and
severity level? (Refer to worksheet—it is easier than the article).
C2
6. What level of severity would C0 indicate? F2? S3?
C0 = minimal F2 = Moderate S3 = high
7. Why is C0F0S0 a suspect HHRG?
The patient is probably not homebound. The HHRG ties to MO700.
8. Please select a patient you are admitting and complete the worksheet provided. What is the patient’s
HHRG based on the scores from your worksheet?
OASIS TEST
1.
MO150 is___The gatekeeper______________________________________
2.
Explain why timely, thorough documentation in the clinical record is so important. What must
documentation support?
It can affect reimbursement and results of surveys. The clinical record must support the OASIS
items affecting reimbursement.
3. What MO numbers may have a substantial impact on adverse events?------ Are there any others you can
think of?
MO270, MO280, MO610, MO830, MO840, MO510, MO450, MO640, MO670, MO680, MO690,
MO780
Transfer/ follow up and discharge OASIS Any emergent care due to falls, deteriorating wound status,
improper med administration or med side effects, hyper or hypoglycemia.
Development of UTI, Increase in the number of pressure sores, decline in 3 or more activities of daily
living, decline in management of oral medications, unexpected nursing home admission, discharged to the
community needing wound care, toileting, or behavioral problems
Unexpected death
A) Choose one of the MO numbers that have an impact on adverse events and explain why.
4. Every problem in the plan of care should be linked to the medical diagnoses___________________.
5. What qualifies as a change in MO200? What does not?
The reason for home care. The request for home care.
6. BRIEFLY explain why you must be careful when answering MO175.
Incorrectly answering the question by indicating that the patient did NOT have a hospital stay within the
14 days prior to the start of care can result in an over-payment to the agency. The OIG has expressed the
opinion that this may be regarded as a fraudulent practice on the part of Home Health Agencies
8. What MO numbers tie into other MO questions and, if answered inaccurately, can lead to
inconsistencies in the OASIS? Give an example.
The following list is not all inclusive—examples may include:
MO680 must be consistent with MO700 and MO690
MO350 must be consistent with 340, 360, 370 and 380
MO560 ties with MO 610 and 620
MO 580 ties with 610, 620
MO 610 ties with MO 780
MO550 ties to MO175
9. What is the focus of MO640 to 820?
Ability is the focus
Willingness and compliance are not
What is not the focus?
10. What is the criterion for prior status?
14 days before the SOC or ROC
11. When assessing grooming, you can go by the way a patient looks.
True
False
12. What is MO680 really asking for?
Mobility 680 must be consistent with 700 and 690
13. How would you score a patient on bathing if he had a post-op incision that had to stay dry? Why is
consistency among clinicians important in answering this question?
The patient would be a 4
It has an impact on future outcomes.
14. What is the difference between MO680 and MO700?
680 measures mobility
700 measures safety
15. Name some ways to assess for ability. (answers will vary)
Always focus on observation as opposed to interviewing. Ask the patient to show you his/her
bathroom for ex. This will allow you to assess MO680 and MO700. 16. Name some ways to assess for
depression? Why is it important to identify depression?
Depression may interfere with ability to learn and ability to improve health status.
17. How would you assess for MO490?
Observe the patient walk 20 feet. Or, for those who can’t walk, note level of exertion when
moving in bed or chair and when talking.
18. If someone used only sign language, how would you answer MO410 and how would you justify your
answer?
#5. MO410 is for speech only.
19. How would you document for MO520?
You must show in your documentation what you are doing to address the issue. For Chronic incontinence
you only need to document once on the length of time it has existed, its cause, supplies being used and
preventive education.
20. What is MO210 asking for? What is the difference between it and MO190?
It is asking for the cause of the change to the patient’s treatment. MO190 is asking what the inpatient
diagnosis was.
21. What is the relationship between OASIS and OBQI?
Answers will vary. Look for responses that demonstrate an understanding of OASIS as a tool for
measurement that contributes to the care planning process and enables one to use the evaluation portion of
the planning process to improve overall agency practices that will benefit present and future patients.
22. What impact does documentation have on reimbursement? ADR’s? Medical review? State Surveys?
How well you document directly affects reimbursement, whether or not a claim is denied, whether or not an
agency may be accused of fraud, and whether or not an agency will receive deficiencies and/or be placed
on a termination track after a state survey.
23. How would you use OASIS to promote effective care planning ?
Answers will vary.