Medicare Compliance & Reimbursement

CMS letter to surveyors fails to clear up confusion.

A new letter to state surveyors supposedly resolves the questions regarding collection of OASIS data for private-pay patients, but critics claim the letter raises more questions than it answers.

According to the Dec. 11 letter, "Effective December 8, 2003, and until further notice, State Survey Agencies (SAs) must not cite any deficiency for [a home health agency's] failure to include the OASIS data set as part of the patient-specific, comprehensive assessment for private pay patients," the Centers for Medicare & Medicaid Services says.

The letter cites as its authority the Medicare Prescription Drug, Improvement and Modernization Act of 2003 that President Bush signed into law Dec. 8 - not the Nov. 5 announcement from then-CMS Administrator Tom Scully on the matter.

The letter to surveyors isn't all HHAs had hoped for. Instead of making the suspension effective Nov. 5, it uses Dec. 8. For agencies that went ahead and discontinued OASIS data collection for non-Medicare, non-Medicaid patients after Scully's announcement, that's a scary prospect.

"They just made [the confusion] worse with the letter," laments Mary St. Pierre with the National Association for Home Care and Hospice. The letter helps those agencies that hadn't yet discontinued private-pay OASIS and were waiting on the written word, but it makes the status of those who already dropped the activity murkier.

The letter may give those agencies an out with the following statement: "Any pending survey findings related to an HHA's omission to collect OASIS data on private pay patients will be suspended."

But CMS says that's because a remedy for such a violation would be to develop a plan of correction that "looks prospectively at the HHA's actions," and agencies can't be required to collect private-pay OASIS data after Dec. 8 anyway.

However, agencies that took Scully's announcement in good faith and acted accordingly are unlikely to be happy with a back-door allowance of the actions, experts say. They want a clean record.

CMS assures NAHC that agencies troubled by surveyors on the issue can call on their CMS regional offices for help, St. Pierre says. "Tom Scully clearly instructed the regional offices to support HHAs in this manner if they were challenged," notes consultant Judy Adams with the Charlotte, NC-based LarsonAllen Health Care Group.

HHAs Can't Drop Private-Pay OASIS Without Consideration 

A good number of agencies are deciding to hang on to their private-pay OASIS data collection anyway, Adams notes. CMS spells out in the letter that they are permitted to do so.

One reason for retaining the duty is because agencies must complete a comprehensive assessment on all patients regardless of payor, she points out. It is often administratively easier to have one assessment form and procedure for all patients.

And maintaining two separate forms increases the chance of "having someone do the wrong form on a patient," Adams says. That could result in a failure to collect OASIS for a Medicare or Medicaid patient, which could lead to a serious ding on the next survey.

In accordance with the Medicare law, the letter explains that CMS will decide whether to reinstate the private-pay OASIS requirement after a study it conducts on the usefulness of the information versus the administrative burden of collection. Agencies won't have to resume collection, if that's what's decided, until final regulations on the matter are published.