Page 79 - Rehab Orientation Manual 12.26.19

Start of Care OASIS

The SOC OASIS is an assessment tool completed at the beginning of the initial episode
of care. The purpose is to:
1. Define a HIPPS code on the answers to the OASIS questions which will dictate the
reimbursement rate;
2. Gather information that will define outcomes of the home care services provided.

HIPPS Code –
2. Responses to specific OASIS questions are organized into 5 domains which produce the
HIPPS code:
5. Admission Source: Institutional vs. Community
6. Timing: Early vs Late
7. Clinical Grouping: Based on the primary reason for Home Health services
8. Functional Impairment Status: Low vs. Medium vs. High
Affected by patient’s level of assist for:
 Grooming
 Upper Body Dressing
 Lower Body Dressing
 Bathing
 Toilet Transferring
 Transferring
 Ambulation/ Locomotion
 Risk for Hospitalization
6. Comorbidity Adjustment; None vs. Low vs. High
4. Each domain has an impact on reimbursement and should be considered during utilization
5. There are 432 case-mix weights/HIPPS codes.

PPS has payment variations
3. LUPA: Low Utilization Payment Adjustment- 30-day periods with a low number of visits are
not case-mix adjusted (paid for the entire 30-day period), but instead paid on a per-visit
basis.
a. LUPA thresholds are variable dependent upon HIPPS code and currently ranges
between 1-5 visits per 30-day period.
4. PEP: Partial Episode Payment- patient is admitted to Agency A, then elects to transfer to
th
Agency B. Agency A receives a proportional payment based on length of stay (1/30 per
day.)

Relationship between OASIS information and the Plan of Care (POC)
3. OASIS and POC must match exactly
4. Accuracy is critical - prepare ahead of time; know what to assess

The SOC OASIS questions are scattered all over the entire PT/ST00 visit. Most of them are in the
Physical Assessment section of the visit note. The SOC visit note is similar to an Add-On

71