QA Nurse changing my Oasis answers!!

Specialties Home Health

Published

Hi, I've only been doing HH for 5 months now, and no one else at my agency seems to have a problem with this...

The field RN's complete the oasis, but cannot lock it, (we're almost completely computerized now). The QA nurse changes the answers as she sees fit, mainly MO questions, in order to get more $$$. In the computer system, the changes are automatically signed by her, because of her login, etc... and computer signature is required. However, when the 485 is sent, it has the field RN's name on it and she is required to sign it. The QA nurse does not sign it, and her name is not on it anywhere. Changes are not sent to the field RN to review and authorize. Does this sound right?

I feel very uneasy about this, but the fact that none of the other RN's mention it at all surprises me. Is there something I don't know?

Anyone have any comments or suggestions?

Specializes in OB, M/S, HH, Medical Imaging RN.

I'm relieved it's a universal problem and not just me. I was beginning to feel so inferior thinking I was making way too many mistakes and may get fired.

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Specializes in ED, PCU, Addiction, Home Health.

Wow - I feel relieved to see that my agency seems to have thier "stuff" together. I have been trained to help review SOC's before we lock them and we NEVER change any items - that charting is the nurses's charting and it would be just like changing someone else's note when I wasn't there.

We've been switching to a new computer system and the next "change" will be that the field nurse locks her own oasis. Our nurses will be pitching a fit, because it's more work for us, but from all your posts - I can see how our agency is trying to set things up to be done "right."

Dawn in PA

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Specializes in ICU, ER, HH, NICU, now FNP.

Couple of things to consider -

1. Just like you SHOULD take every tax deduction on your tax return to which you are legally allowed, so should your agency take every item of reimbursement which they are legally allowed - as long as it is not fraudulent.

2. You as an RN can be held just as liable for Medicare fraud as any agency administrator or owner.

Just two points to keep in mind. In other words - educate yourself well to the ways of medicare, stay on top of changes, and know how your intermediary is likely to interpret the rules. Intermediarys often offer free classes and online training resouces. Trailblazer here in Texas for instance has a wealth of free online training materials and frequently holds seminars for free in our area!

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Specializes in ICU Stepdown, Home Health.

Thanks for all the replies!

I think the thing that makes me feel uncomfortable is that the QA nurse is not asking me to change my answers, but she changes them herself, and then I don't get to see the 485 again until after it's been sent to the MD and to Medicare. So I am signing something that is not completely "mine". Another nurse has changed my answers and her name isn't on the 485. So if there ever was a problem from MEdicare's viewpoint, who will be held responsible? Me--I'm sure the agency will be, as well.

Would that make ANYONE else uncomfortable? Or am I just worrying for nothing?

I completely understand needing to change answers sometimes to get the best reimbursement that we can get. I have been educated about the Oasis, and we are educated on an ongoing basis at my agency. My knowledge of how to fill out complete the Oasis is not the issue.

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Specializes in ICU, ER, HH, NICU, now FNP.

I wouldn't want my sig on something that was not mine.

Would you blindly sign a chart note you had not written without seeing it? The same concept applies here. If she is going to change it then SHE should sign it - which she can't do because she didn't see the patient. If she doesn't agree with the way you are doing them, then it sounds like the two of you need to sit down together and discuss it.

This changing things could definately be considered fraud though.

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Specializes in ICU Stepdown, Home Health.

The Oasis is not just a typical assessment, some of the questions are easy to misunderstand if you're in a hurry. And it is very important for the SOC nurse to assess accurately for several reasons. We are eventually going to be paid by our outcomes, and if SOC assessment is off, then it messes up the outcomes at discharge/recert.

I can definitely see a need for the QA nurse to be "anal" about how the Oasis is filled out, but the policy should be that she also signs the 485 if we are not given a chance to review it before it's locked. I think I'll have a talk with the Director about this.

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Specializes in ICU Stepdown, Home Health.

The Oasis is not just a typical assessment, some of the questions are easy to misunderstand if you're in a hurry. And it is very important for the SOC nurse to assess accurately for several reasons. We are eventually going to be paid by our outcomes, and if SOC assessment is off, then it messes up the outcomes at discharge/recert.

I can definitely see a need for the QA nurse to be "anal" about how the Oasis is filled out, but the policy should be that she also signs the 485 if we are not given a chance to review it before it's locked. I think I'll have a talk with the Director about this.

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I do believe that every RN working in home health should educate herself on the oasis questions and how to properly assess for and answer them. Medicare has several educational sources on this subject that are excellent for the home health RN. The answers should be well thought out and checked over for accuracy. She shouldn't answer these questions with just reimbursement in mind, but by the same token, it should not be totally disregarded either. All home health agencies should provide mandatory education on the Oasis and they should make it as fun and interesting as possible. But as you know, from my previous posts, nurses (or anyone for that matter but MOSTLY nurses) changing an RN's documentation (and this IS documentation don't forget that) makes the hair stand up on the back of my neck. These people should be asked: "would you take a patient chart and pull out regular visit nurses notes and start arbitrarily changing what these nurses documented to the point that it no longer resembles what she initially charted?". Most will look at you as though you had just asked them to rob a bank. Why? because changing a nurse's documentation is falsification in documentation in the worst sense. It's bad enough when you falsify your OWN documentation....and it can lead to severe punishment by state boards of nursing for an R.N. or LPN. Imagine what the treatment and punishment would be for a nurse who changed ANOTHER nurse's documentation would be? That would be the hot seat not to be in. I would think that if a nurse took the bold (and not so smart) step of changing a nurse's documentation, it would be for the desperate cause of absolute must to simply save herself from being hung in the notes...or to simply cover up a mistake she made (hopefully not one that caused any harm to a patient). However, RN's, LPN's and other staff routinely and nonchalantly changing an RN's documentation simply for the financial gain of the agency puzzles me to no end...how does this happen, how does a nurse get to that point? What factors are considered when she makes the decision to risk everything she is worth in order to step up the dollar amount paid to the agency for which she is employed? One of these days, along will come an RN who will discover her documentation is being changed and she will react strongly by notifying her state board of nursing. Thing is, they won't just investigate her complaints, but they will look to see if a pattern of abuse has occured. I think it's safe to say--- that home health agency will sound more like sunday morning at church with all the praying and gathering that will be taking place.

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First of All... Ladies... please remain calm and take a deep breath. None of you are headed for nurse jail simply because an OASIS has been changed by another person. Please note the COS-C attached to my name. That stands for Certified OASIS Specialist-Clinically. I use a change form each and every time an item is incorrectly answered by a clinician. I note the needed change or the inconsistent answers on the form.... phone the clinician... discuss the inconsistency and make the change as needed. This is perfectly legal as long as it is done with the collaboration of the OASIS clinician. The clinician then signs the change form used and it is kept in a file...NOT in the patient's medical record. No need to alert a surveyor of OASIS collection problems. There is more than reimbursement involved with changing an OASIS answer. Outcomes depend on correct answers on each OASIS timepoint. Clean data is essential for many reasons. Let me tell all of you that it is certainly no fun being the reviewer and having to phone clinicians day in and day out to discuss simple concepts that seem to be difficult to grasp. An example of this is the common inconsistency between M0560/M0570/ M0400 and M0410. A clinician states a patient has dementia, lives in a board and care, is confused day and night and YET mark Zero on M0400 and M0410. How can it be said that a patient is demented and confused but able to hear AND understand the spoken language (M0400) or expressing their needs without difficulty (M0410.?) The question in M0400 is not only whether the client can hear, But, also, can they understand what they hear. Maybe that can be so, but, it's very doubtful. That's why the discussion with the OASIS clinician is essential to arrive at the correct answer. There are numerous other areas that need clarification, but, this book is long enough. Thanks for your time. You have a great day and remember that there is no field as good as the home health field. Sincerely, June

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First of All... Ladies... please remain calm and take a deep breath. None of you are headed for nurse jail simply because an OASIS has been changed by another person. Please note the COS-C attached to my name. That stands for Certified OASIS Specialist-Clinically. I use a change form each and every time an item is incorrectly answered by a clinician. I note the needed change or the inconsistent answers on the form.... phone the clinician... discuss the inconsistency and make the change as needed. This is perfectly legal as long as it is done with the collaboration of the OASIS clinician. The clinician then signs the change form used and it is kept in a file...NOT in the patient's medical record. No need to alert a surveyor of OASIS collection problems. There is more than reimbursement involved with changing an OASIS answer. Outcomes depend on correct answers on each OASIS timepoint. Clean data is essential for many reasons. Let me tell all of you that it is certainly no fun being the reviewer and having to phone clinicians day in and day out to discuss simple concepts that seem to be difficult to grasp. An example of this is the common inconsistency between M0560/M0570/ M0400 and M0410. A clinician states a patient has dementia, lives in a board and care, is confused day and night and YET mark Zero on M0400 and M0410. How can it be said that a patient is demented and confused but able to hear AND understand the spoken language (M0400) or expressing their needs without difficulty (M0410.?) The question in M0400 is not only whether the client can hear, But, also, can they understand what they hear. Maybe that can be so, but, it's very doubtful. That's why the discussion with the OASIS clinician is essential to arrive at the correct answer. There are numerous other areas that need clarification, but, this book is long enough. Thanks for your time. You have a great day and remember that there is no field as good as the home health field. Sincerely, June

But no one mentioned this "change" form in the preceding posts.....so i would gues that is NOT what is happening.....

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