OASIS-Central

Q: If you are doing a ROC assessment in the middle of the episode, should you answer M0110 “NA”- No Medicare case mix group to be defined by this assessment? I believe this is the correct answer since there are no SCIC adjustments, but have not been able to get a clear answer.  We do answer early or late if the ROC is in the last five days of the episode. Is this correct?

A: In situations when a Resumption of Care (ROC) is not used to determine the payment under PPS for the current or upcoming episode, a response of “NA” would be acceptable for M0110. Alternatively, the clinician may choose to report the same M0110 response that was reported at the SOC (or Recert) assessment that began the current episode, or they could report UK – Unknown.

When a ROC assessment is completed during the last five days of the episode and will be “used as a recert” (i.e., used to determine payment for the upcoming 60 day episode), then the ROC data will be necessary to define a case-mix group. In this case, if Medicare PPS is the payer, clinicians should select 1- Early, if the upcoming episode is the 1st or 2nd adjacent episode, or 2-Later, if the upcoming episode is the 3rd or greater adjacent episode. A response of UK – Unknown can be selected if the clinician does not know the information. (Source: CMS OCCB Q&As – April 2008)