Keeping Up with OASIS Documentation Makes Financial Sense

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By Terry Miller, RN 
Regulatory Analyst, McKesson

Home Health Software Cost Savings

Failing to submit OASIS data in a timely fashion could have negative bottom-line impacts for your home health agency, according to a February report from the Office of the Inspector General (OIG). The report, Limited Oversight of Home Health Agency OASIS Data , underlines the importance of staying on top of home health regulation issues so your agency doesn’t run afoul of the law.

OIG looked at all home health Part A claims and Outcome and Assessment Information Set (OASIS) records from 2009 to determine how many were missing the required OASIS record. As part of its investigation, OIG also surveyed states about their responsibilities surrounding OASIS, conducted interviews with CMS staff and obtained a list of home health agencies that had been penalized by CMS from 2007-2010.

The study found that 6% of claims (more than 392,000) did not have the required OASIS data. Those claims represented more than $1 billion in Medicare payments. Additionally, 15% of home health agencies were late with their OASIS documentation.

CMS has a powerful tool at its disposal to compel greater compliance, the ability to assess a 2% payment penalty. However, the OIG report found that fewer than 200 agencies were penalized during the four-year period covered in the report.

OIG spread the blame, chastising states for not reviewing the accuracy of OASIS documentation and CMS for not monitoring state processes or ensuring the accuracy of data itself. The agency recommended that agencies failing to submit OASIS data be penalized by 2%, which CMS agreed to. But CMS did not agree with two additional recommendations, to penalize agencies that submit data late and to develop clear guidelines for states regarding “timely and accurate” OASIS data.

Using  home health software from a trusted vendor like McKesson is a sure way to keep up with compliance issues.  Horizon Homecare™ has long included the functionality to actively stop a final claim for a Medicare or Medicaid payor when the OASIS has not been submitted to the state, thereby supporting your home health agency’s efforts to remain compliant – and avoid possible payment penalties.

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