Home Health & Hospice Week

With the OASIS matching edit now in place and denying claims that lack a supporting OASIS, home health agencies are being more careful than ever to get their OASIS data in before submitting final claims.

However, that may be leading to a new problem for some HHAs — recoding of a claim’s HIPPS code when it doesn’t match what’s coded on the OASIS.

HHH Medicare Administrative Contractor CGS offers some tips to figure out what’s going on with your mismatched claims. For example, “when the OASIS HIPPS code is billed with a 1 (early episode) and the number of therapy visits fall between 0-13, the claim may recode the 4th position based on the number of therapy visits billed,” CGS explains. “When this occurs and the 1st position of the HIPPS code remains a 1 (the same as the recoded HIPPS), the only position that will recode is the 4th. This also applies to HIPPS codes that begin with a 2, 3 and 4.”

Exception: The HIPPS code will not recode “when it begins with a 5 and has 20+ therapy visits billed,” the MAC says.

On the other hand, “if the HIPPS code is a 1 and is recoded to a 2, 3, or 4, the treatment authorization code was used to recode the entire HIPPS code,” CGS tells providers on its website. “This also applies if the HIPPS code is billed with a 2, 3, or 4 and the 1st position changes.”