Home Health & Hospice Week

Pay based on OASIS HIPPS code, not claims.

It’s no joke — starting April 1, you’ll get paid for the OASIS responses you submit rather than the HIPPS code on your reimbursement claim.

New way: The Medicare claims system will match up claims with their corresponding OASIS records. “If the matching process determines that the OASIS-calculated HIPPS code is different from the one submitted on the claim, the OASIS-calculated HIPPS code will be used for payment,” the Centers for Medicare & Medicaid Services says in a new MLN Matters article.

Loophole: “If an OASIS assessment corresponding to the claim is not found, the claim will process normally at this time,” CMS says.

However, don’t expect that exception to last for long. “Submission of an OASIS assessment for all HH episodes of care is a condition of payment,” CMS notes in the article. “CMS plans to use the claims matching process to enforce this condition of payment in the earliest available Medicare systems release. At that time, Medicare will deny claims when a corresponding assessment is past due in the QIES but is not found in that system.”

Just how long it will take CMS to make that change is unclear. The requirement to match OASIS records with HIPPS claims was actually contained in a 2012 transmittal. CMS spent 2013 testing the matching process for inpatient rehab facilities (IRFs), then implementing it for IRFs in 2014. CMS began testing the matching process for HHAs last year.

Watch for: “CMS will provide notice to HHAs as soon as possible after we determine the implementation date” for the edits that will deny claims with no matching OASIS records, the agency adds in the MLN Matters article.

More information, including how to identify payment adjustments due to matching errors, is in the article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1504.pdf.