Home Health & Hospice Week

The relatively recent requirement for an OASIS to be present to process a claim may be bringing to light many minor data errors you didn’t even know you had.

For example: One of the elements that must match between the claim and the OASIS record is Beneficiary Medicare Number (OASIS item M0063). “If OASIS item M0063 is left blank when the OASIS is transmitted, the QIES will accept the OASIS and will not generate a warning message,” explains HHH Medicare Administrative Contractor Palmetto GBA in new article on its website. “However, when the final/end of episode claim is submitted, the system will be unable to locate a corresponding OASIS, which will result in the claim being RTP” or Returned to Provider.

If you catch this error before submitting the final claim, you must submit a corrected or modified OASIS before submitting that claim, CGS advises. “If the claim is RTP, submit a corrected OASIS before retransmitting the claim,” the MAC instructs.

Remember: “A claim that is RTP cannot be appealed,” Palmetto stresses. “Providers must make the necessary corrections … and retransmit the claim.”

Do this: “Before the final claim (also known as an End of Episode or EOE claim) is submitted, providers should review their OASIS validation reports to ensure that the OASIS was transmitted and accepted,” Palmetto instructs. “If there are fatal errors, the OASIS will be rejected. For minor errors, the OASIS may be accepted, but the validation report will contain warning messages. Providers are encouraged to submit a corrected OASIS, when appropriate, to address the errors by submitting a corrected/modified OASIS.”

Resource: For many more scenarios that lead to RTP’d claims due to no matching OASIS, which is indicated with reason code 37253, see Palmetto’s article at www.palmettogba.com/palmetto/providers.nsf/vMasterDID/AMWNFB4380.