Home Health & Hospice Week

Tip: Include OASIS transmission record when you respond to an ADR.

Missing OASIS assessments might be more common than you think — and will torpedo your claims.

In edits of low case mix claims by HHH Medicare Administrative Contractor NHIC, one of the common reasons for denial was "Outcome and Assessment Information Set (OASIS) was not documented," NHIC says on its website. "The OASIS is required to be submitted to the state repository," NHIC explains.

This is an issue that Recovery Audit Contractors also are focusing on, reports Judy Adams with Adams Home Care Consulting in Asheville, N.C. RAC interest in this area is "relatively new," Adams notes.

Region C RAC Connolly Inc. listed "OASIS not completed timely" as an approved issue on its website last November (see Eli’s HCW, Vol. XXII, No. 12).

This issue seems bizarre, experts agree. Adams hasn’t come across this problem much. Perhaps "the HHAs are just not transmitting the OASIS timely and the claim is being submitted before the OASIS is in the system," Adams guesses.

But maybe the problem is just that reviewers aren’t matching up the correct claims and OASIS, NHIC suggests. "When submitting records for Medical Review, consider including the OASIS transmission record or tracking sheet," the MAC tells providers. "This assists the reviewer in accessing the OASIS record for the appropriate claim."