Quick And Easy OASIS Documentation Tips

To carry out an accurate assessment, you need to understand the OASIS questions and use appropriate strategies. Read the OASIS Implementation Manual, Attachment B, which gives you item-by-item tips for each OASIS question.

MO230 Primary Diagnosis. Choose the diagnosis that reflects the chief reason for home care. This diagnosis must match the primary diagnosis listed on the POT.

MO240 Other Diagnoses. If the primary reason for home care is a manifestation code, use this code in the first slot of MO240 and list the etiology code in MO230.

MO250 Therapies the patient receives at home. Only include those therapies the patient is receiving or will receive as a result of this assessment at home.

MO390 Vision. Assess the patient's vision with corrective lenses if the patient normally wears them.

MO420 Frequency of pain interfering with patient's activity or movement. Identify frequency of pain interfering with activity with treatment if prescribed.

MO440 Does this patient have a skin lesion or open wound? A skin lesion is an alteration in skin integrity. It does not include: anything ending with 'ostomy' or peripheral IV sites. It does include: central lines, PICC lines, implanted infusion devices, venous access devices, bruises, age spots, sores, skin tears, burns, ulcers, rashes, surgical incisions with sutures or staples, pin sites, crusts, persistent redness without a break in the skin, etc.

MO450 Current # of pressure ulcers at each stage. The bed of the ulcer must be visible to stage the ulcer. If the ulcer is covered with eschar, necrotic tissue or a non-removable dressing, it cannot be staged. Do not reverse stage 3 or 4 granulating pressure ulcers.

MO482 Does this patient have a surgical wound? A surgical wound includes: orthopedic pin sites, central line sites, stapled or sutured incisions, incisions with approximated edges and a scab, debrided graft sites, wounds with drains, Mediport sites and other implanted infusion or venous access devices.

MO520 Urinary incontinence or presence of urinary catheter. If patient has anuria or an ostomy for urinary drainage, mark response #0. If patient is incontinent AT ALL, mark response #1. If patient requires the use of a urinary catheter, mark response #2. If patient is both incontinent and requires the use of a urinary catheter, mark response #2 and follow the skip pattern.

MO530 When does urinary incontinence occur? Any incontinence that occurs during the day should be marked with response #2.

MO640 - MO820 ADLs and IADLs. To assess the patient's ADL and IADL status, use direct observation supplemented by interview.

MO650 - MO660 Ability to dress upper and lower body. If patient uses dressing aids, assess ability using aids. If patient requires standby assistance for safety or verbal cueing, mark response #2. Consider physical limitations at the time of assessment and pain as well as clothing routinely worn.

MO670 Bathing. Assess the patient's ability to bathe the entire body and possible assistance to safely bathe. Use response #2 or #3 for patients requiring standby assistance or verbal cueing. If patient cannot use the bath or shower because they are restricted by an MD order or unable to access second floor tub or shower due to restriction from stair climbing, use response #4 or #5.

MO680 Toileting. Assess the patient's ability to safely get to and from the toilet or beside commode. This does not include ability to perform personal hygiene.

MO690 Transferring. Assess the patient's ability to transfer safely for the three transfers indicated. Only use the response #2 if the patient can both bear weight and pivot.

MO700 Ambulation/Locomotion. Assess ability to walk safely once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces. If the patient requires standby assistance or verbal cuing, use response #1 or #2. A patient who is able to take one or two steps to transfer but is otherwise unable to ambulate, should be considered chair-fast, so choose #3 or #4.

MO826 For all Medicare fee-for-service patients. The total of all physical, occupational, and speech-language pathology combined visits must be reasonably estimated.

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The History of the Forex Markets, Sometimes Called the Currency Markets

Traders centuries ago often exchanged goods and services with other countries that utilized a different currency than there own, because of this a form of a currency exchange program has been in existence for an extremely long time.After all, what good does it do to come home with a form of money that nobody will accept?We will discuss the evolution of trading currencies from its root to the present time.In addition, trading in gold will be mention as well as the Bretton Woods Agreement.
Gold Exchange and its Interaction with the Bretton Woods Accord:

In 1967 an individual attempted to short the British Pound by taking out a loan from a United States bank.

Instead of in taking out the loan in US dollars he attempted to have it done in British Pound Sterling.The bank did not make the loan due to the wording of the accord called Bretton Woods.

The purpose of the pact was to help stop gambling that a currency would increase or decrease in value.Previous to this, currencies were backed up by a national governments holding of gold as a reserve.This practice provided confidence to the public, since they knew they could exchange there money for gold at any time.

But, it was a very inefficient economically maintaining such large amounts of assets not producing any economic benefit for society.In addition, it limited federal government's ability to expand the money supply and provide an economic stimulus to the country.

This governmental policy had server consequences on a nation's economy causing it to have wild swings between prosperity and recession.This would happen when countries gold reserves would decrease as it imported products that needed to be paid for with gold.Since the currency of a country was backed by the gold it held, as the gold reserves decreased so did the supply of money in the economy.This would have a negative effect on the prices of other commodities such as; corn, oil and sugar.

As these prices dropped other countries would then start buying them in massive amounts which were paid for in gold.Thus the gold reserves would increase and the money supply would follow.The effect on interest rates would be to decrease them and the economy would come out of the depressed period and start performing better.This pattern was continually repeated until World War One began and the trade between decreased due to logistical problems.

Due to the economic might of the United States after World War Two the US dollar increased in value verse the currencies of the European nations.Countries where not permitted to devalue there currencies over ten percent in an attempt to improve there economies through exports.Obviously, many nations have not adhered to this agreement; one only needs to look at China as an example of extreme currency manipulation in an effort to improve exports to the determent of there trading partners.

The Bretton Woods Accord was initiated after World War Two in an attempt to provide order and standardize the international currency markets.The principle reason for this was to maintain the value of a particular currency with in a narrow range, thus bringing a since of balance to the market as the countries could then exchange goods and have advanced knowledge of what value they would receive in return for there goods or services.

In 1971 the United States announced that a US dollar could no longer be exchanged for gold.This process freed up the worlds currency and permitted them to float on a free market and have there value determined by what investors where willing to pay for them.

The amount of funds being traded daily has increased significantly over the decades.From the billions in the 80's to the trillions today.The volume, speed and volatility of the markets has also increased rapidly with improved technology and the popularity of the internet.

The EURO Dollar Market Takes Off Like A Rocket:

This explosion was initially started by the Russians selling oil to the rest of the world and receiving US currency in exchange for there oil.

Since Russia was afraid of a potential conflict with the United States they started depositing there US dollars in banks outside of the control of the US government.When this happened huge amounts of US dollars where now in banks outside of the US.

Because of this the US government enacted laws restricting lending to non US citizens.Then a strange thing happened, US based companies realized there were sizeable amounts of US dollars outside of the US that they could borrow at very favorable rates, in fact they were much more competitive than the interest rates they were presently able to get from a US bank.

In the 1980's British banks began lending US dollars and because of this they have remained the number one market for US dollars outside of the US.In addition, because of there liberal laws and geographical location many countries around the world utilize London as a principle source of financing and Forex exchange.

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We have researched, tested and reviewed 100's of Forex Training Courses, Software Systems and Brokerage Firms.

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For the internets MOST comprehensive FREE Forex learning tools, which included 100's of FREE training articles and FREE tutorials check out FREE FOREX TRAINING.Good luck on the trading floor today!William R.Alheim, Jr., CPA, MA

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Is Your Local Chamber of Commerce Obsolete

Wandering into the San Jose, California Chamber of Commerce one wonders what sorts of local businesses are members. After all, San Jose is Silicon Valley Central and the home to many of the worlds best known companies.

As one glances at the list of members what is conspicuous is the absence of the heavy hitters. What is also conspicuous is that of the tens of thousands of businesses in San Jose only a very small percentage bothers to join the San Jose Chamber of Commerce.

In the old days local C of Cs were places to advertise and promote your local business. Somehow being a member and paying your 150 yearly fee would put you among the local elite and raise the credibility of your company.

But as in the San Jose Chamber of Commerce most local businesses are not members as well as the "bigger and more important" local businesses.

But its not just San Jose. Go to any local C of C and more than likely you will find the same thing. Why

A big picture analysis shows that the concept of "local" has changed. Technology and specifically search technology has opened the world to the local consumer with more than just local options.

In the old days one did business with those that one knew or knew of locally; now the local consumer can do business with any company they find searching the Internet.

The "Buy Local" programs have simply become obsolete as the concept of local has lost its meaning.

The inference once was that local consumers were looking for businesses and a good way to find reliable businesses was through the local Chamber of Commerce member list. Actually this idea died in the 1970s and 1980s and was in reality not a member benefit by 2000.

In the past a new business would join hoping to gain local exposure and maybe get some extra business. The badly maligned Mixers would help serve this function.

New members were told to bring their "pitches" and stack of business cards and hand them out at the mixers. So in effect the mixer became a big "lets sell to ourselves" exercise, as rarely do non-Chamber members attend the mixers.

Local collective ads were once another way the local Chamber could promote its members; through brochures, local newspaper and magazine ads, an occasional TV or radio spot. As mass media has gotten more expensive, the collective ads have gone by the wayside.

And like many organizations, the local C of Cs have been hit hard financially in the recent economic downturn. As their cash flows have diminished, the Chambers ability to hire and retain good staff had diminished as well.

Hence, all the ubiquitous job postings for Chamber Executive Directors. Part of the "executive package" is that the executive director must raise money to pay for herself.

This means that the primary function of the executive director is not promoting local business but raising enough money to keep the Chamber above water.

But in all fairness, its not just the executive directors fault; what can a group do locally to promote themselves

The biggest complaint today is that the Chamber does little or nothing for its members so it has become harder and harder to justify the time and 150 fee. The first question a new prospect asks is what is in it for my business

If the expectation is increased business, as many new members hope, then the expectation turns to disappointment over time. Thats too bad.

Communities need a strong business community to thrive and communities with a weak business community have problems.

The simple fact is that the local C of Cs are delivering less and less value to their members. Unless the local Chambers are able to redefine their mission and find ways to bring greater value, the Chambers will simply go the obsolete route of newspaper advertising.


About the Author

Jack Deal owns JD Deal Local Search marketing and Deal Business Consulting, Santa Cruz and Salinas, California 95076 831-457-8806. Related articles, ideas, strategies, tactics and tips can be found at

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