Home Health & Hospice Week

Monitor closely to be sure your payments are correct under the new process.

Get ready for payment adjustments as an OASIS matching requirement for your claims starts April 1 — but it probably won’t severely disrupt your cash flow in this phase.

Under the new process, the Medicare claims system will match up home health agency 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 Medi-care & Medicaid Services says in a recently updated MLN Matters article.

Good news: “I don’t think that there will be a huge effect as of April 1,” says Melinda Gaboury with Healthcare Provider Solutions in Nashville.

“Most home health software is tightly integrated with OASIS results and claim generation, so I don’t feel there will be an unintentional issue at the provider level,” agrees Lynn Olson with billing company Astrid Medical Services in Corpus Christi, Texas.

Bad news: Potential problems would likely come on the claims system or software vendor side, Olson worries. “I am concerned with integration at the CMS processing level, and how the software vendors will handle a change if a provider needs to make an adjustment,” Olson tells Eli.

Billing expert M. Aaron Little with BKD in Springfield, Mo., is concerned about “whether the new process will work correctly, especially in the early days of implementation,” he says. “It has taken so long for this new process to be implemented, and it’s my understanding that when it was implemented for the other Medicare segment that it had some problems.”

Background: CMS included the requirement to match OASIS records with HIPPS claims in a 2012 transmittal. The agency 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.

Logistical problems seem to have delayed the HHA application. Hopefully CMS has thoroughly worked out those kinks. “Anything that potentially delays Medicare payments — even slightly — is of concern for most providers,” Little observes.

Tip: “Providers would be well served to closely monitor payments to ensure the process is working correctly,” Little advises. v

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