OASIS Alert

Multiple payors can throw clinicians for a loop when answering M0150, but this item need not be a point of consternation for home health agencies.

The instructions accompanying M0150 direct agencies to identify all payors to be billed during the current home care episode. "If a patient is receiving care from multiple payers (e.g., Medicare and Medicaid; private insurance and self-pay; etc.), include all sources," the directions read.

Despite this guidance, clinicians often mark only the primary payor, reports consultant Rose Kimball with Med-Care Administrative Services in Dallas. Some agencies are reluctant to mark multiple payor sources because they worry that acknowledging a patient has insurance other than Medicare will impact the HIPPS code assignment, which could reduce reimbursement, she notes. "But that's simply not the case."

It's important to respond to this question accurately and thoroughly because "assessments for Medicare and Medicaid patients are handled differently than assessments for other payers," the OASIS instructions remind agencies.

If you know a patient has insurance pending, but it isn't in effect at the time of your assessment, do not mark that payor source on M0150; you should indicate only active payors, experts note. Similarly, if you know for certain of one or more payor sources, but are unsure of additional ones, mark only those that you know for sure.

Sometimes an agency doesn't realize a patient is eligible for Medicare or Medicaid and thinks private insurance will foot the bill. If that turns out not be to the case, the agency has no choice but to transmit the OASIS assessment to Medicare late, notes consultant M. Elaine Graves with MEG Associates Consulting Group in Hudson, CO.

To ensure that you are aware of all payor sources, check with your referral source, the patient and/or caregiver and your billing office, and obtain copies of patient insurance cards from the patient/ caregiver, the Centers for Medicare & Medicaid Services instructs.