OASIS Alert

Published on Tue Nov 02, 2010 PDF

Avoid denials with this expert advice.

Now's the time to ensure your OASIS data submission practices are above reproach.

The National Association for Home Care & Hospice "recently learned that at least one contractor for the Centers for Medicare & Medicaid Services has begun auditing home health claims for OASIS data submission during the conduct of medical review," NAHC says in its member newsletter. "In cases where OASIS start-of-care or recertification data for episodes under review were not submitted to the state, claims were denied in full." Agencies haven't seen harsh penalties for failing to submit OASIS data until now, NAHC notes. They've been subject to survey citations and market basket inflation update reductions.

Bottom line: "Entire home health claims are now subject to denial if agencies do not submit start-of-care and recertification assessments for every Medicare episode to the state," NAHC warns.

Don't be surprised to see Zone Program Integrity Contractors (ZPICs) and Recovery Audit Contractors (RACs) pick up this topic in the future, NAHC cautions.

The edit based entirely on data is right up RACs' alley especially, industry observers note.

Do this: Check your OASIS and claims submission procedures to make sure your OASIS data is going in before your final claims for those episodes, NAHC urges. That includes checking with outside vendors. And "agencies must ensure that the HIPPS code on the final claim matches that received on the OASIS validation report," NAHC adds.