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PPS PERFORMANCE OPTIMIZER TOOLKIT:
HIGH-YIELD SOLVED QUESTIONS AND FINAL
EVALUATION TRANSCRIPT FOR
OPERATIONAL READINESS SUCCESS 2026
โ Homebound Criteria? Answer: 1/ aid of supportive devices leaving home medically contraindicated
both normal inability to leave home Requires cosiderable & taxing effort โ Outcome and Assessment Information Set (OASIS) Answer: determine acuity/needs of pt influences medicare reimbursement Completed at: SOC/ROC, transfer, recert, DC/death โ Hx of OASIS Answer: 1999 Outcome measures, improvement/stabilization, show potentially avioidable events OASIS D: January 2019--sections GG (fnal ability & goals) and J (health conditions)
โ PPS for HH Answer: 60 day episode Casemix adjustment: payment based on condition & needs LUPA: <5 skilled visits in episode PEP: readmission during 60 day episode โ Current Home Health PPS Answer: HHRGs based on levels (CSF scores) Clinical: Dx & additional conditions Functional: pt ability to dress/bathe toilet/transfer/amb Service Utilization: based on # visits/60 days โ OASIS Outcomes Answer: SOC - > DC SOC - > Transfer to inpt facility ROC - > DC ROC - > Transfer to inpt facility โ Risk Adjustment Answer: Compensation for differences in pt population โ SOC Answer: IE If pt eligibility in question: STOP
โ Recert Answer: assessment during last 5/60 days home visit required All professions can complete MUST have physician order โ Discharge Answer: from agency: not due to TIF or death NOMNC provided (48 hr notice) Visit required to complete assessment Last discipline out completes OASIS โ General Oasis Guidelines Answer: Physical/cog/psychological/environmental/med contraindicat/SAFETY โ OASIS questions sections Answer: M, GG (fnal activities/goals), J (falls) โ General OASIS Conventions Answer: based on day of assessment "usual status" "At/since most recent SOC/ROC" "One calendar day" - > midnight next day "Prior status" steady state
โ Dx Coding Primary M1021 Answer: why we see pt for HH supported Confirmed w/ MD โ Dx Coding Additional Dx M1023 Answer: Comorbidities โ Dx Coding Pain M1242 Answer: chage in fn due to pain more assistance? night pain โ Dx Coding Respiratory Status M1400 Answer: O2 use While completing ADLs โ Dx Coding Manage Oral Medications M2020 Answer: ability to do so noncompliance is NOT inability โ Considerations for ADL/IADLs Answer: Ability: SAFETY, phys, cog, sensory, environmental impairments Current status SBA/cueing โ Dx Coding Transfers M1850 Answer: AD & assist from caregiver -
โ PDGM Motivation Answer: Results ACA: more vulnerable populations MedPAC: HH benefit should not be based on # visits but based on patient characteristics โ PDGM Case Mix Subgroups Answer: Admission source Timing 30 day period Clinical grouping Functional Impairment Comorbidity Adjustment โ PDGM Admission Source Answer: Institutional: Inpt ACH, SNF, IRF, LTACH, psych facility WITHIN 14 DAYS Community: no admission within 14 days else increased reimbursement โ PDGM Timing Answer: Early: first 30 day period Late period: subsequent requires gap 60+ days between 30 day periods โ PDGM Clinical Grouping Answer: 12 groups based on primary dx โ PDGM Functional impariment Level Answer: low/med/high
based on OASIS questions โ PDGM Comorbidity Adjustment Answer: Low: 1 2a Dx High: 2+ comorbidities No: no reported comorbidities โ HH Eligibility Answer: MD, DO, podiatrist: orders approved and followed, Face to face encounter for primary reason 90 days prior SOC or w/in 30 days Requires skilled professional maintenance/improvement Part time intermittent care Homebound Requirement
