Posted on Friday, October 26, 2018 12:18 PM
One Clinician Rule Expansion: What Agencies Need to Know
By: Amanda Gartner RN, BSN, MSN, COS-C, Clinical Analytics Manager at Corridor
Based on feedback from home health stakeholders, CMS modified the home care guidance related to the one clinician convention and implemented the change in January of 2018.
Agencies should have policies in place on how they are using this collaborative ruling especially with the implementation of OASIS-D approaching, which includes therapy driven questions with GG0130 Self Care and GG0170 Mobility in which multidisciplinary collaboration is encouraged. Only one clinician can take responsibility for completing the comprehensive assessment; however, the rule allows the assessing clinician to elicit feedback from other agency staff including but not limited to contracted staff, physicians, therapist, pharmacists, family members, etc. on any or all OASIS items. Please reference CMS Quarterly Q&A April and July 2018 for further clarification on the use of the one clinician rule.
Collaboration would need to follow the appropriate timeframe and data collection guidance for each OASIS assessment type (see Table). Any additional information used to supplement the OASIS assessment should be reflected in M0090 date.
Corridor reviewers use this collaborative approach to ensure the comprehensive assessment is completed accurately. An important factor to consider is if the multidisciplinary approach is going to be utilized, that clinicians need to see the patient within the qualified time-period. Occasionally when RN/PT/OT are all ordered therapist don’t make it in the home within the qualified time-period for a variety of reasons, and therefore the visits cannot be used to supplement the comprehensive assessment. Whenever possible is best practice for all ordered disciplines to see the patient within the qualified time-period for their assessment input to be used on the OASIS assessment.
|
Assessment Type |
Assessment Time Frame for Collaboration |
|
Start of Care |
Five days after the SOC (SOC = day 0) |
|
Resumption of care |
Within 2 calendar days of the facility discharge, knowledge of the discharge or the ROC visit date (in the event of a M0102 date) |
|
Recert |
Last 5 days of 60-day episode |
|
Planned Discharge |
Last 5 calendar days the patient received visits |
|
Unplanned Discharge |
Last qualifying clinician assessment plus last 5 calendar days the patient received visits |
About Corridor
Corridor is the nation’s preferred partner and trusted business advisor to home health and hospice providers, providing quality services and impactful results for 30 years. Focusing on key operational, regulatory and financial challenges, Corridor delivering industry-unique solutions and deep expertise in coding, clinical documentation review, compliance, billing and collections , consulting and provider staff education . At Corridor, we make the business of caring for people Better! For the most important industry updates and news that impacts home health and hospice, please make sure to sign up for our weekly newsletter to receive the latest up-to-date industry information direct to your inbox!
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