OASIS Alert

Published on Fri Aug 17, 2007 PDF

Beware a pattern of errors waving a red flag.

A new report from the HHS Office of Inspector General signals the government's continued interest in home health agencies' accuracy in coding OASIS item M0175 (From which of the following inpatient facilities was the patient discharged during the past 14 days), experts say. Like other audits in recent years, a July 26 OIG report notes that an agency's mistakes in coding M0175 led to Medicare overpayments.

But the report also shows that the Centers for Medicare & Medicaid Services is likely to recover little by continuing to try to recoup post-edit M0175 overpayments, experts predict. The audit found that Medicare had overpaid the VNA Care Network of Worcester, MA, about $6,200 in 2004 and 2005 -- out of total claims paid in those years of about $437,000.

You can't rely on your fiscal intermediary's edits to prevent M0175 overpayments. Beginning in 2003, FIs implemented pre- and post-payment edits to catch M0175 errors in their favor. But of the 161 claims the VNA Care Network submitted with M0175 overpayment errors in fiscal years 2004 and 2005, the edit caught only 138 of them.

Note: The report (A-01-06-00514) is at http://oig.hhs.gov/oas/reports/region1/10600514.htm.