Home Health & Hospice Week

CMS unveils surprising new twist

Home health agencies could face a serious threat to their cash flow, thanks to a new OASIS rule taking effect June 21.

After that date, you may not have to lock your OASIS data within seven days, but you won't be able to submit a request for anticipated payment (RAP) until you transmit the OASIS data. The unexpected result of the new OASIS reporting regulation surfaced in the May 24 Home Health, Hospice and DME Open Door Forum that drew 366 listeners.

The new reg is in response to industry requests for more time to audit OASIS data before locking it, Centers for Medicare & Medicaid Services official Pat Sevast told the forum audience. But agencies may submit the RAP only after completing the data transmission, she confirmed.

Before: The current rule allows agencies to file a RAP after the seven-day OASIS data lock.

After: Beginning June 21, CMS will require HHAs to lock and transmit OASIS data within 30 days of the assessment completion date found in OASIS item M0090. A new error message will address any failure to comply with this timing.

"I'm just in shock," says reimbursement consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville, TN. "It's going to be bad."

"This policy change would negatively impact agency operations and cash flow," warns Mary St. Pierre with the National Association for Home Care & Hospice. That's because HHAs' software currently checks only for the lock date before allowing RAP submission, not the transmission date. CMS sprang this on agencies and vendors so close to the effective date that they may not have time to update their billing systems.

Added burden: Under the new rules, agencies will have to transmit OASIS data daily to submit RAPs, NAHC warns. "The process for creating an OASIS batch for transmission, particularly for agencies that rely on CMS HAVEN software, takes no less than 30 minutes to an hour each time RAPs are batched for submission."

The additional workload will be "overwhelming," Gaboury fears. This is such a big change that "I don't see how CMS can implement or monitor it by June 21," Gaboury tells Eli.

Requirement's Future in Doubt

And it's not just RAP submission and payment that will be affected, predicts consultant M. Aaron Little with BKD in Springfield, MO. The change will also throw off recognition of revenues for accounting purposes.

Confusion ahead: It also could delay posting of episodes to the Common Working File, Little cautions. That means other HHAs, medical suppliers, hospices and rehab facilities may bill and get paid for services or supplies on overlapping dates of treatment, which will have to be sorted out later.

NAHC is requesting a meeting with CMS in hopes of modifying this requirement before the effective date hits, the trade group says.

"I hope it's a mistake," Gaboury says.

In fact, CMS may not be able to enforce the rule, especially with nothing proposed in writing, maintains reimbursement and cost report consultant Bobby Dusek in Abilene, TX. The requirement isn't stated anywhere in the regulations, including the regulation for the lock date change published in the Federal Register last Dec. 23 (see Eli's HCW, Vol. XV, No. 1).

"I would ignore it until written guidance comes out," Dusek says of the transmission requirement for billing RAPs.

Ahead: Expect related changes to the OASIS User's Manual in Chapters 2, 5 and 10, as well as revisions to Chapter 8 sometime this summer, CMS said.

Important: Clinicians still must complete the OASIS assessment within five days. And agencies may not perform repeated assessments within the 30-day period before data transmission and choose the one they want to send, Sevast said.