OASIS-Central

Q: Is there a rule on grace days concerning M0090?  For example, I have a SN SOC on 6/1 and a PT eval on 6/7. Can I add PT to the admission plan of care?

A: The assessing clinician has up to five (5) days after the start of care date to complete the assessment. When counting the 5-day window for completion of the OASIS assessment, the start of care date counts as day 0. In this example, the five-day window ends on 5/6. For the purposes of completing the OASIS, details from the PT evaluation cannot be included in the OASIS assessment, since they occurred after the five-day window.

The Conditions of Participation (CoPs) §484.18 (a) require that agencies develop a plan of care in collaboration with the patient’s physician that contains specific requirements, including services and frequency of visits. The CoPs do not place time frames on completion of the plan of care, although agencies cannot submit the Request for Anticipated Payment until the plan of care has been submitted to the physician for signature. This CoP states that if “a physician refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician is consulted to approve additions or modifications to the original plan.” If the agency chooses to develop a plan of care that includes more thorough orders than those provided in the referral orders, it should be evident in the clinical record when the physician was contacted to provide and/or approve those services. This could be in the form of a communication note or verbal order.