Home Health & Hospice Week

If you’ve been operating under the mantra “No OASIS, No Problem,” get ready to change come April 1.

Why? That’s the date the Centers for Medicare & Medicaid Services will begin enforcing its requirement that home health agencies have an OASIS to back up every claim, CMS says in MLN Matters Article No. MM9585. “If the OASIS assessment is not found in the QIES upon receipt of a final claim for an HH episode and the receipt date of the claim is more than 30 days after the assessment completion date, Medicare systems will deny the HH claim,” CMS explains. “While the regulation requires the assessment to be submitted within 30 days, the initial implementation of this edit will allow 40 days.”

HHAs can recognize when a claim is returned for this reason because Medicare will use the following remittance messages: Group Code “CO” and Claim Adjustment Reason Code 272.

Reminder: Medicare already has an edit in place that changes your claim’s HIPPS code if it doesn’t match with the corresponding OASIS assessment answers. But currently if there is no OASIS in the system, nothing happens (see Eli’s HCW, Vol. XXIV, No. 21).

See the article at www.cms.gov/Outreachand-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9585.pdf.