OASIS Alert
Study Explains M0 Mistakes
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With pay for performance on the horizon, a new study highlights problems with OASIS validity and reliability. The study findings suggest OASIS may not truly reflect the patient's condition. This supports industry experience, experts say.
The study, conducted by the Visiting Nurse Service of New York's Center for Home Care Policy and Research, found reliability for many items "considerably lower than prior studies" including those conducted by the University of Colorado's Center for Health Policy Research.
VNS-NY, which describes the study in the Home Health Care Services Quarterly, points out significant problems with inter-rater reliability and concludes that previous studies "had not accounted for the stresses and unpredictability of the home health care setting."
Best advice: Training is very important because repeated use of OASIS alone does not improve accuracy, VNS-NY researcher Robert Rosati tells Eli. "Training should reinforce the importance of observing functional abilities and emphasis should be placed on clarifying the subtle differences between answer choices in the OASIS items," he advises.
Note: The article is in Home Health Services Quarterly, Vol. 24, No. 3.
• The HHS Office of Inspector General released Jan. 25 another in its series of audits of home health agency claims with 10 to 12 therapy visits. Intermediary Cahaba GBA determined that half the sampled 100 claims of Springfield. MO-based Oxford Healthcare were incorrect--resulting in an overpayment of more than $600,000. Oxford disagreed with many of the reviews.
The OIG claimed most of the errors were from lack of medical necessity. For example, it disallowed one out of 10 visits made after therapy goals were met and five out of 10 visits where services provided were not medically necessary. Other errors included doctor's orders signed and dated after the claim was filed and incorrectly used case-mix diagnoses. The report is at www.oig.hhs.gov/oas/reports/region7/70401010.pdf.
• Regional home health intermediary Palmetto GBA has revised its Local Coverage Determinations (LCDs) for home health occupational therapy, physical therapy and speech language pathology.
The revisions, including changes to CPT and HCPCS codes, took effect Jan. 1. The LCDs are available at www.cms.hhs.gov/mcd/search.asp.
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Study Explains M0 Mistakes
With pay for performance on the horizon, a new study highlights problems with OASIS validity [...]