Do we have to make changes at the 30-Day time point? Yes! The Claims Processing Manual states that “each claim must represent the actual utilization over the period.” So if the focus of care for the first 30 days is resolved by day 28, you must update the diagnosis list for the second 30 day payment period to reflect the focus of care for services over that period.
What’s the purpose of the 30-Day update?
- Identify any changes in diagnoses during the current payment period (days 1-30) for the next RAP and claim (days 31-60)
- Identify any changes in focus of care or services for days 31-60, re-sequence diagnosis list if needed
- Capture any changes to the claim for current payment period (days 1-30), which will be unusual
- Identify any changes due to a ROC or SCIC
(double check to make sure nothing missed)
- ROC OASIS completed?
- ROC order written with any diagnosis changes?
- Have SCIC criteria been met (significant changes in functional score) and no Other Follow-up completed? (Remember: no OASIS needed for diagnosis changes only!)
What information needs to be collected at the 30-Day time point?
- Any new diagnoses
- Is there an order or medical record documentation?
- Any exacerbated diagnoses or conditions
- Any resolved conditions
- Healed wound, infection resolved, etc.
- Any change in focus of care for days 31-60
- Any new or discontinued medications
- May change Z79.- codes on POC/claim
- Any verification of diagnoses present since the start of the current payment period that were verified late (after the RAP for days 1-30 was filed)
Does your software system have tools that will help track this information?
Who is going to review the record? Who knows the patient best? The case manager – use an ongoing tracking tool to turn in on day 30? The biller – does he/she know what to look for in clinical notes? The coder – does the coder really need to check every case, or just those with changes in diagnosis or meds?
Take the opportunity for a quick case conference at the 30-day time point, and collaborate with other disciplines seeing the patient:
- Making progress toward goals?
- If you scored key OASIS items today, would patient show improvement? If not, what can you change in your POC to gain improvement?
- Need to revise the POC interventions or goals?
- Discharge plan still acceptable to patient and family?
- Anticipating recert or discharge at the end of the next 30 days?
Teresa Northcutt, BSN, RN, COS-C, HCS-D, HCS-H
Senior Associate Consultant, Selman-Holman, Briggs Healthcare