1. Patient Tracking OASIS-C Contact: Cindy Skogen, RN (OEC)
, or
for questions.
Source: Center for Medicare and Medicaid Services
The items in this section can be included on a separate Patient Tracking Sheet, if the agency chooses. These are typically items that don’t change very often. If the items are pulled from the comprehensive assessment and included on a separate Patient Tracking Sheet, the clinician will need to remember to go back to the tracking sheet and update when needed. Example, at each ROC, the M0032 date will need to be updated.

2. M0010 CMS Certification Number
__ __ __ __ __ __
Agency’s CMS Certification Number
If not Medicare-certified – leave blank
This is NOT the provider’s NPI number
Preprinting on clinical documentation allowed and recommended

3. M0014 Branch State (M0014) Branch State
__ __
State where the agency branch office is located
Leave blank if:
Agency has no branches or if you are the parent agency

4. M0016 Branch ID Number (M0016) Branch I D Number
__ __ __ __ __ __ __ __ __ __
Branch ID code, as assigned by CMS
No branches, enter "N" followed by 9 blank spaces.
A parent HHA that has branches, enter "P" followed by 9 blank spaces.
Preprinting this number on clinical documentation is allowed and recommended.
If ID code listed in M0016, then M0014 cannot be blank

5. M0018 National Provider Identifier
(M0018) National Provider Identifier (N P I) for the attending physician who has signed the plan of care __ __ __ __ __ __ __ __ __ __
⃞ UK – Unknown or Not Available
National Provider Identifier (NPI) for the physician who will sign the POC
Replaces UPIN of "Primary Referring Physician ID"

6. M0020 Patient ID Number (M0020) Patient I D Number
__ __ __ __ __ __ __ __ __ __ __ __ __
Agency-specific patient ID used for agency recordkeeping for this episode of care
May stay the same from one admission to the next
May change with each admission
Should remain constant throughout a single episode of care, e.g. SOC – DC
Leave spaces at the end blank

7. M0030 Start of Care Date (M0030) Start of Care Date:
__ __ /__ __ /__ __ __ __ month / day / year
Date the first reimbursable service delivered
If HHA policy/practice is for RN to perform SOC assessments in therapy only cases
The RN assessment must be same day or within 5 days after the therapy provides billable service
Used as part of the PPS logic. Also used for Quality Measures.

8. M0032 ROC Date (M0032) Resumption of Care Date:
__ __ /__ __ /__ __ __ __ month / day / year
⃞ NA – Not Applicable
Resumption of Care Date (ROC)
Date of first visit following an inpatient stay by patient currently on service
ROC date must be updated on Patient Tracking Sheet (PTS) for each ROC

9. M0032 NA at SOC The most recent ROC should be entered
HHAs who always DC patients when admitted to inpatient facility will not have a ROC date
CMS Q & A October 2010
Question 2: New text in the Medicare Claims Processing Manual, CMS Publication 100-4, Chapter 10, reads, “A beneficiary does not have to be discharged from home care because of an inpatient admission. If an agency chooses not to discharge and the patient returns to the agency in the same 60-day period, the same episode continues. However, if an agency chooses to discharge, based on an expectation that the beneficiary will not return, the agency should recognize that if the beneficiary does return to them in the same 60-day period, the discharge is not recognized for Medicare payment purposes. All the home health services provided in the complete 60-day episode, both before and after the inpatient stay, should be billed on one claim." Does this mean that providers should never do an RFA7 (Transfer with discharge)? CMS OCCB Q&As – October 2010 ( Page 2 of 6  
Answer 2: When a patient is transferred to the inpatient facility, it should be assessed if the agency anticipates the patient will be returning to service or not. If the HHA plans on the patient returning after their inpatient stay, the RFA6 should be completed. There will be times when the RFA7 is necessary to use, but only when the HHA does NOT anticipate the patient will be returning to care. There are several reasons why the RFA7 may be used, including these examples: the patient needs a higher level of care and no longer appropriate for home health care, the patient’s family plans on moving the patient out of the service area, or the patient is no longer appropriate for the home health benefit.
The Claims Processing Manual clarified this issue in July 2010, and directs providers to not discharge a patient when goals are not met at the time of a transfer. If a provider does discharge and readmit within the same payment 60-day episode, a Partial Episodic Payment (PEP) adjustment will be automatically made.

10. M0040 Patient Name __ __ __ __ __ __ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __ __ __ __ __
(First) (M I)
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
(Last) (Suffix)
Enter name exactly as it appears on Medicare or other insurance card
Patient’s legal name
Sequence of the names may be reordered
Update PTS if change occurs during episode

11. M0050 Patient State of Residence
__ __
Where the patient is CURRENTLY residing while receiving home care
Even if not usual or legal residence
Update PTS if change occurs during episode

12. M0060 Patient Zip Code (M0060) Patient Zip Code
__ __ __ __ __ __ __ __ __
Zip code for address where patient is receiving home care
CURRENT residence, even if not usual or legal residence
Used on Home Health Compare to determine where HHA provided service
Emphasize how important accuracy is to quality reporting on Home Health Compare.

13. M0063 Medicare Number
(M0063) Medicare Number: __ __ __ __ __ __ __ __ __ (including suffix)
⃞ NA – No Medicare
For Medicare (MC) patients only
Use RRB number for railroad retirement program
Enter claim number from MC card
May or may not be Social Security number
No MC, mark “NA-No Medicare”

14. M0063 Medicare Number
If MC HMO, another MC Advantage plan or MC Part C
Enter MC number if available
If not available, mark “NA-No Medicare”
Do NOT enter the HMO ID number
Leave spaces at the end blank

15. M0064 Social Security Number
__ __ __ - __ __ - __ __ __ __
⃞ UK – Unknown or Not Available
Include all nine numbers
Mark “UK” if unknown or not available
Information cannot be obtained
Patient refused to provide information

16. M0065 Medicaid Number (M0065) Medicaid Number
__ __ __ __ __ __ __ __ __ __ __ __ __ __
⃞ NA – No Medicaid
Specifies the patient’s Medicaid (MA) #
No MA coverage or MA coverage pending, mark “NA - No Medicaid.”
If patient has MA, complete item whether or not MA is reimbursement source for the home care episode.
Number assigned by individual state
Found on the patient's Medicaid card

17. M0066 Birth Date (M0066) Birth Date: __ __ /__ __ /__ __ __ __
month / day / year
Month, day, and four digits for the year
E.g., May 4, 1930 = 05/04/1930
Item necessary for computation of quality outcomes

18. M0069 Gender (M0069) Gender: ⃞ 1 - Male ⃞ 2 - Female
The easiest OASIS M item
1 - Male
2 - Female

19. M0140 ⃞ 1 - American Indian or Alaska Native
(M0140) Race/Ethnicity: (Mark all that apply.)
⃞ 1 - American Indian or Alaska Native
⃞ 2 - Asian
⃞ 3 - Black or African-American
⃞ 4 - Hispanic or Latino
⃞ 5 - Native Hawaiian or Pacific Islander
⃞ 6 - White
Instructional Guidance
Instructions to Class

20. M0140 Race/Ethnicity
Specifies groups or population to which the patient is affiliated
As identified by the patient or caregiver (CG)
Used for tracking disparities
If the patient does not self-identify
Referral information
Hospital or physician office clinical record
Observation

21. M0140 Race/Ethnicity (cont.)
Response 1: American Indian or Alaska Native.
Origins in any of the original peoples of North, South America & Central America
Maintains tribal affiliation or community attachment.

22. M0140 Race/Ethnicity (cont.)
Response 2: Asian.
Origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent
Examples: Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

23. M0140 Race/Ethnicity (cont.)
Response 3: Black or African American
Origins in any of the black racial groups of Africa.
Terms such as “Haitian”, “Negro”, “Black” or “African American”

24. M0140 Race/Ethnicity (cont.)
Response 4: Hispanic or Latino.
Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
"Spanish origin," can be used in addition to "Hispanic or Latino."

25. M0140 Race/Ethnicity (cont.)
Response 5: Native Hawaiian or Other Pacific Islander.
Origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Response 6: White.
Origins in any of the original peoples of Europe, the Middle East, or North Africa.

26. M0150*
(M0150) Current Payment Sources for Home Care: (Mark all that apply.)
⃞ 0 - None; no charge for current services
⃞ 1 - Medicare (traditional fee-for-service)
⃞ 2 - Medicare (HMO/managed care/Advantage plan)
⃞ 3 - Medicaid (traditional fee-for-service)
⃞ 4 - Medicaid (HMO/managed care)
⃞ 5 - Workers' compensation
⃞ 6 - Title programs (e.g., Title III, V, or XX)
⃞ 7 - Other government (e.g., TriCare, VA, etc.)
⃞ 8 - Private insurance
⃞ 9 - Private HMO/managed care
⃞ Self-pay
⃞ Other (specify) _____________________
⃞ UK - Unknown
*If responses 1, 2, 3, and/or 4 are checked, Medicare certified HHAs must complete and transmit OASIS per CoP requirements
Instructional Guidance
Instructions to Class

27. M0150 Current Payment Sources
Limited to identifying payers to which any services provided during this home care episode and included on the plan of care will be billed by your home care agency
Must be accurate
Assessments for MC and MA patients are handled differently than for other payers
Emphasize this reports just payers to which any services provided during this home care episode and included on the plan of care will be billed by your home care agency - Not every payer they have

28. M0150 Current Payment Sources
Mark all current pay sources
Primary or secondary
Exclude “pending” pay sources
Multiple payers reimbursing for care
Include all sources, e.g., MC, MA, private insurance, self-pay
If one or more payment sources
Include known, NOT uncertain ones

29. M0150 Current Payment Sources
Do not consider any equipment, medications, or supplies being paid for by the patient, in part or in full
Response 2 - MC HMO, another MC Advantage Plan, or MC Part C.
Response 3 - MA waiver or home and community-based waiver (HCBS) program.

30. M0150 Current Payment Sources
Response 6 – Title programs
Title III – State Agency on Agency grants
Title V – State programs for maternal and child health
Title XX – State program for homemaking, chore service, home mgmt, or aide services

31. M0150 Current Payment Sources
Response 7 – Tri-Care program
Replaced CHAMPUS
Response 10 – Patient is paying for all or part of the care
e.g., copayments

32. Items to be Used at Specific Time Points
The following slides detail which items are required at each time point.

33. Items to be Used at Specific Time Points (cont.)
Start of Care
Start of care—further visits planned
M0010-M0030, M0040- M0150, M1000-M1036, M1100-M1242, M1300-M1302, M1306, M1308-M1324, M1330-M1350, M1400, M1410, M1600-M1730, M1740-M1910, M2000, M2002, M2010, M2020-M2250
Resumption of Care
Resumption of care (after inpatient stay)
M0032, M0080-M0110, M1000-M1036, M1100-M1242, M1300-M1302, M1306, M1308-M1324, M1330-M1350, M1400, M1410, M1600-M1730, M1740-M1910, M2000, M2002, M2010, M2020-M2250
Follow-Up
Recertification (follow-up) assessment
Other follow-up assessment
M0080-M0100, M0110, M1020-M1030, M1200, M1242, M1306, M1308, M1322-M1324, M1330-M1350, M1400, M1610, M1620, M1630, M1810-M1860, M2030, M2200

34. Items to be Used at Specific Time Points (cont.)
Transfer to an Inpatient Facility Transferred to an inpatient facility patient not discharged from an agency
Transferred to an inpatient facility — patient discharged from agency
M0080-M0100, M1040-M1055, M1500, M1510, M2004, M2015, M2300-M2410, M2430-M2440, M0903, M0906
Discharge from Agency --
Not to an Inpatient Facility
Death at home
Discharge from agency
M0080-M0100, M0903, M0906
M0080-M0100, M1040-M1055, M1230, M1242, M1306-M1350, M1400-M1620, M1700-M1720, M1740, M1745, M1800-M1890, M2004, M2015-M2030, M2100-M2110, M2300-M2420, M0903, M0906

35. Questions??? E-mail: health.oasis@state.mn.us
Cindy Skogen, RN;
Oasis Education Coordinator