Home Health & Hospice Week

OASIS submission difficulties are putting home health reimbursement in jeopardy.

Another week has gone by under the Patient-Driven Groupings Model with no solutions announced for OASIS submission problems with the new iQIES system.

Recap: Nearly 90 percent of home health agencies had gotten onto the new Internet Quality Improvement and Evaluation System (iQIES) system as of Jan. 8’s Home Health Open Door Forum, but iQIES was rejecting certain OASIS files, Centers for Medicare & Medicaid Services officials confirmed (see Eli’s HCW, Vol. XXIX, No. 2). CMS switched OASIS submission to the iQIES system on Jan. 1.

In the forum, CMS acknowledged some of the problems attendees reported as known issues and said they were working on them, as well as on a way to inform agencies of what is happening. But at press time, the agency had made no announcements about progress on the iQIES issues. A CMS spokesperson didn’t respond to a request for comment by press time.

“I know there are still problems,” says Mary Carr with the National Association for Home Care & Hospice.

“We have been engaged with CMS on the issue,” adds NAHC President William Dombi. CMS says it is working on it, but “they do not have a firm timeline for fixing it,” Dombi tells Eli.

“We’re still hearing of a variety of issues regarding iQIES … including incorrect duplicate rejections, errors specific to reopening, and resubmitting,” relates Nick Seabrook with BlackTree Healthcare Consulting in King of Prussia, Pennsylvania. Problems with retrieving correct MBIs persist for both Medicare and Medicare Advantage patients, Seabrook tells Eli. But agencies have been able to obtain correct MBIs through other avenues and resubmit OASIS files successfully.

The problem is that the OASIS matching edit will kick back claims that don’t have a matching OASIS file. “Since it is a requirement for OASIS to be on iQIES to allow billing to process … this presents an impediment to getting payments processed,” says Joe Osentoski with Gateway Home Health Coding & Consulting in Madison Heights, Michigan.

This glitch begs the question of why CMS implemented the new iQIES system at the same time PDGM launched. The iQIES rejections are a “totally unneeded issue for agencies to address while dealing with PDGM, reduction of RAP payments, OASIS change, and for some the continued RCD under PDGM process,” Osentoski maintains.

The good news: Some HHAs “don’t even realize it’s an issue” because their files are going through with no problems, Seabrook points out.

The bad news: “This issue is going to continue to increase in severity if the errors aren’t fixed,” Seabrook notes. “Many of our clients are already submitting their first PDGM claims and that list is only going to grow.”

Watch out: “If an agency is not on top of their claim processing and billing game, they may be in serious financial jeopardy quickly,” Osentoski warns.

Before You Cry iQIES Glitch, Check These 4 Items

If you are having trouble with OASIS matching, make sure iQIES problems are really the culprit, and not your own errors. “Reason Code 37253: No Corresponding OASIS Assessment Found” was already a top claims submission error last fall, HHH Medicare Administrative Contractor CGS said on its website at the time.

Remember: These items on the OASIS file and claim must match, CGS pointed out in its September post:

• Home health agency Certification Number (OASIS item M0010),
• Beneficiary Medicare Number (M0063),
• Assessment Completion Date (M0090), and
• Reason for Assessment (M0100).

As of Jan. 1, the Beneficiary Medicare Number should be an MBI. But multiple providers have reported problems with using MBIs in iQIES, industry sources say.

At the time, CGS urged providers to “ensure the OASIS assessment has completed processing and was successfully accepted into the Quality Information and Evaluation System (QIES) National Database” before submitting a claim. “Verify this by reviewing the OASIS Agency Final Validation Report or OASIS Submitter Final Validation Report for the submission which included the assessment. These reports will provide information that confirms the assessment’s receipt, the date of receipt, and any fatal or warning errors encountered.”

This is the step that agencies can’t complete when iQIES won’t accept their OASIS files.