Home Health & Hospice Week

Providers frustrated with lack of transparency.

It will be another week or two before many home health agencies see how their PDGM claims fare under the new payment system, but many providers are already encountering a major obstacle to obtaining their rightful reimbursement in the new year.

The Internet Quality Improvement and Evaluation System (iQIES) is rejecting certain OASIS files, Centers for Medicare & Medicaid Services officials confirmed in the agency’s Jan. 8 Home Health Open Door Forum. About 89 percent of HHAs have currently “onboarded” to the iQIES system that took effect Jan. 1, a CMS staffer shared.

How validation reports are displaying is one iQIES problem, a CMS staffer explained initially. Then CMS officials confirmed their knowledge of iQIES rejecting OASIS records for various issues, including when the original OASIS record was submitted in the “legacy” system and is modified in iQIES.

On Jan. 7, the National Association for Home Care & Hospice reported receiving a message from CMS discussing the validation report problems. CMS’s “iQIES team is actively working to resolve multiple issues with the data that is displayed on these reports,” CMS reportedly told the trade group. “The design issue with the report makes it difficult for users to … determine exactly why their submissions are rejected when multiple errors with the submission [have] occurred. Many providers also referenced the 30-day late rejection error when, in fact, the rejection error was related to a different issue,” CMS said, according to the group’s listserv.

The deadline for submitting OASIS by 30 days after the assessment should just produce a warning edit, not result in a record rejection, CMS officials in the forum pointed out. “The data display/alignment of the report makes it difficult to track the actual error that caused the assessment to be rejected,” CMS told NAHC. “We have also received feedback that data overall was missing from the validation reports.”

In both the forum and the message to NAHC, CMS pledged that the iQIES team is working to address the problems.

Multiple providers expressed their worries and frustrations over the rejections. One provider related her experience of not being able to reach iQIES help desk support via phone or email. CMS recognizes there currently are “long wait times for responses,” a CMS source acknowledged in the forum. “We are aware and we are working on that as diligently as possible.”

Multiple providers asked for information on exactly which iQIES problems CMS knows about and for a progress report on their resolutions. One caller asked for a source for information similar to HHH Medicare Administrative Contractors’ claims issue log pages.

No such resource currently exists, but the CMS reps pledged to take the idea “back to the team.”

Another provider asked for CMS to list the iQIES problems in the forum so HHAs would know what the status is. A CMS staffer said he was unprepared to do so.

“If we can’t successfully get an OASIS accepted, we can’t bill,” another caller criticized. “Our bills are being held up.”

The CMS official pledged to “get the information to you as quickly and efficiently as we possibly can. Thank you for your patience.”

In the meantime: Just “hold tight” on those OASIS files the system is erroneously rejecting, the CMS source advised. Resubmitting the files will just result in another rejection.

If the iQIES problems go on much longer, home health agencies will have Condition of Partici­pation compliance to worry about in addition to payment problems, NAHC’s Mary Carr told CMS in the forum. Submitting OASIS within 30 days of assessment is a COP requirement, she pointed out.