Description: The article is about noridian medicare portal. The article also covers about the section O service utilization. By viewing these training modules people will understand more about HIS coding and learn how it may help us and our hospice.
Welcome to the Centers for Medicare and Medicaid Services module the section O service utilization. This module will introduce learners to HIS section O service utilization which includes items O0500 level of care in final three days O0510 number of hospice visits in final three days,O0520 level of care in final seven days and O0530 number of hospice visits in 3 to 6 days prior to death.
This is the seventh of eight modules in the larger series His coding guidance. The series is intended for users who are familiar with His coding and submission guidelines for newer users we recommend starting with the His manual and older trainings first. These modules will not cover all items in all sections. Learners may choose to listen to the entire series or may choose to listen to one or two modules that are of most interest to them. It means the modules in this series can be watched independently or as a group.
Included here on slide two is a list of acronyms that will be used in this presentation which listed in alphabetical order. After completing this module,learners will be able to identify the items that compose section O service utilization describe the intent of the measure and describe the quality measure calculations by using section O data.
Items in this section correspond to the hospice visits when HIS imminent measure pair. Section O contains key information about service utilization and includes two types of items,level of care items and visit items. Items in this section are intended to capture information about level of care,routine homecare,continuous homecare,general impatient care and respite care and the number of hospice staff visits provided to the patient in their final three days of life and final three to six days of life.
Level of care is particularly important because visit items are completed for patients on routine homecare only. Complete section O items only for discharges ending in death where A2115 reason for discharge equals O one expired. So before we delve into each section whole item individually let’s go over some general guidance for completing the two types of items in this section, level of care items and visit items.
Let’s go over some general guidance for level of care items first. When completing the two level of care items O 5,000 and O 50 20,you can consider the level of care is not the setting of care. For example if a patient is residing in a hospice inpatient unit or facility,but he is receiving routine home care level of care,you would consider the level of care routine home care. The levels of care are defined in the hospice conditions of participation and include routine home care,continuous home care general inpatient care and inpatient respite care.
Let’s review some overarching guidance for completing the visit items which are items O fifty ten and O fifty thirty. Let’s start with what counts as a visit. For the purpose of completing the visit items,phone calls are not counted. Additionally post-mortem visits are not counted. But visits began when the patient was still alive may be counted even if the patient dies during the visit.
Visits to family may be counted such as visits by the chaplain or the MSW to provide support to the family. Now let’s look at whose visits can be counted. Individuals whose visits can be counted for the purpose of completing O5010 and O5030 include hospice staff members in each of the listed disciplines who are either employees,contractors and affiliates.
For example staff from the quality division of the health system to which a hospice belongs or who provide unpaid services. For example a chaplain or spiritual counselor who is an unpaid staff member at the hospice. Although visits from unpaid staff members are included,visits from volunteers are not counted in section O with that general guidance under our belts. Let’s look now at each section O item individually starting with O 5,000.
O 5,000 captures the level of care the patient received in the final three days of life. It is essentially asking you whether the patient received a level of care other than routine home care. If a patient received continuous home care general inpatient care or respite care in the final three days of life,answer yes to O5,000 and skipped to ZO400. In this sense O5000 is a gateway question to the remaining items in Section O. If the patient received any level of care other than routine home care in the final three days,you can skip all remaining section O items.
O fifty ten is the first of the two visit items. It reports the number of visits provided by the hospice staff from the indicated discipline in the final three days of life. So this item covers visits received in a three day time window. To begin counting the final three days of life,the day of death is the same day as the discharge date. One day prior to death is calculated as A0270 minus one and two days prior to death is calculated as a 0270 minus 2. A0270 is the discharge date on the HIS discharged.
To know which visits to count for this item,remember the tips we went over on slide 7 included disciplines are listed for your reference here on slide 9. The next item is O5020. This is our second level of care item. This item reports the level of care received by the patient in the final seven days of life. So the content of the question is seems like the other level of care item only the timeframe is different. If the patient received continuous home care general inpatient care or respite care in the final seven days of life,you would again follow the HIS Skip pattern.
In this case if a 5000 is yes indicating the patient received a level of care other than routine home care,you can skip the final section O item and move on to Z0 400. Note that the timeframe for this item does overlap with the timeframe for the prior level of care item. O0530 is the final item in section O and reports the number of visits received by the patient from a given discipline three days prior to death four days prior to death five days prior to death and six days prior to death. So the content of this visit item is like the content of the first visit item only for a different time frame. This item is looking at a four day time window. The time window in O0530 does not overlap with the time window in the prior visit item.
The time window is calculated as follows. Three days prior to death is calculated as a 0270 which is the discharge date minus three. Four days prior to death is calculated as a zero to 70 the discharge date minus four and so forth. To know which visits to count for this item,remember the tips we went over on slide 7.
Included disciplines are the same as those for the prior visit item. Now let’s look at the corresponding QM for the items in section O. The QM associated with section O is a bit different than the other HIS QMS because this measure is a measure pair.
Measure one is the percentage of patients receiving at least one visit from registered nurses,physicians,nurse practitioners or physician assistants in the last three days of life. To meet the numerator criteria,a patient must have received at least one visit from a registered nurse,physician,nurse practitioner or physician assistant in the last three days of life.
It’s important to note here that to meet the numerator criteria,the patient only has to receive one visit in total. The patient does not have to receive one visit from each of the name disciplines to meet the numerator criteria for measure one.
For the second measure in the pair,measure 2 is the percentage of patients receiving at least two visits from medical social workers chaplains or spiritual counselors licensed practical nurses or hospice aides in the last 7 days of life. To meet the numerator criteria,a patient must have received at least two visits from MSWS,chaplains or spiritual counselors,licensed practical nurses or hospice aides in the last seven days of life.
Similar to measure one,to meet the numerator criteria for measure two,the patient does not have to receive a visit from each of the listed disciplines. For measure,two the patient only has to receive two visits total from any of the named disciplines to receive credit for the measure. This concludes our presentation on section of service utilization.
While the series overall is intended for users who are familiar with HIS coding and submission guidelines,information regarding the hospice quality reporting program can be found by clicking the hyperlink on this resource slide. This resource slide also contains hyperlinks to specifics on the HIS hospice quality measures,the QM user’s manual and the HIS manual v2 with the change table.
The hospice quality helpdesk is available to assist with general questions about the hospice quality reporting program. This concludes the module section O service utilization. This module covered the items in section O including distinguishing between the level of care and the visit items as well as the appropriate time frame for each item. This module also covered the specifications for the hospice visits when death is imminent measure pare.
This is the seventh of eight modules in the series hospice item set coding. The other modules in this training series are listed here and we encourage you to view these training modules as well to understand more about HIS coding and learn how it may help you and your hospice.