Home Health & Hospice Week

Reimbursement:

CMS Debunks 3 OASIS-Claims Matching Myths

OASIS corrections won’t derail your claim.

If you’re worried about how Medicare’s new OASIS matching requirement for claims is going to affect your bottom line, you may find some comfort from clarifications offered in the latest Home Health Open Door Forum.

The requirement for claims to have a matching OASIS assessment or face denial takes effect April 1. “If the OASIS assessment is not found in the QIES upon receipt of a final claim for an HH episode and the receipt date of the claim is more than 30 days after the assessment completion date, Medicare systems will deny the HH claim,” CMS explains in MLN Matters Article No. 9585 (see Eli’s HCW, Vol. XXV, No. 39-40). CMS will give HHAs an extra 10 days leeway to start, with a 40-day window after the assessment.

Clarification No. 1: The requirement applies to end of episode claims only, not Requests for Anticipated Payment (RAPs), a CMS official spelled out in the Nov. 16 forum.

Clarification No. 2: It won’t matter if your OASIS file is submitted late, as long as it’s in the database when the final claim processes. In other words, a late OASIS won’t trigger a denial if it is present, the CMS staffer said.

Clarification No. 3: Correcting an already received OASIS won’t trigger a denial under this edit.

Note: See more details in the MLN article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9585.pdf.

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