What You Need to Know About a Significant Change in Condition
Summary
Under PDGM, there will be more instances of Significant Change in Condition (SCIC) assessments than seen under the previous prospective payment system. A SCIC adjustment occurs when a patient experiences a major decline or improvement in condition (as defined by the agency) without qualifying for inpatient admission. Asking the Right Questions When it comes to a SCIC, the most important questions you can ask your team are: CMS revealed in an OASIS Q&A that if there is a diagnosis change between one 30-day claim and the next, there is no requirement for the home health organization to complete an RFA 5 Other Follow-Up assessment to ensure that diagnosis coding on the claim matches the OASIS assessment. CMS expects agencies to have and follow specific policies that determine the criteria for when an Other Follow-Up assessment must be completed. The criteria for updating a comprehensive assessment include: Many agencies believe that performing a SCIC will increase payment for the second 30-day billing period, but that is not always the result.
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