OASIS Alert

Your FI may be wrong.

Test Your OASIS Savvy ...

Q: True or False: Fiscal intermediaries may downcode claims if documentation in the record contradicts OASIS answers, but not if documentation is not in the record to support OASIS answers.

A: True. OASIS stands alone, insists Mary St. Pierre with the National Association for Home Care & Hospice. CMS' policy -- clearly spelled out in the fiscal intermediary's manual -- is "don't deny or downcode a claim for failure to have substantiating documentation other than the OASIS," she told attendees at the recent NAHC National Policy Conference in Washington.
 
If you document something in OASIS and don't contradict it in the record, the OASIS documentation is sufficient to pass medical review scrutiny, St. Pierre said. At first FIs didn't understand this, but there have been few "horror stories" recently, she reported. "If intermediaries are downcoding claims for failure to have supporting documentation elsewhere in the record, I'd like to hear about it, so we can take steps to correct it," St. Pierre urged. Inappropriate FI downcoding is something NAHC will continue to address, she added.