OASIS claims are required for payment!

This seems like an obvious post, but there are agencies having trouble … note the specificity language AND the denial language regarding OASIS as a condition for payment ….

Beginning January 1, 2010, home health agencies (HHAs) were required to submit an OASIS as a condition for payment. Contractors may deny the claim as a result of not meeting this regulatory requirement. The assessment must be patient specific, accurate, and reflect the current health status of the patient. This status includes certain OASIS elements used for calculation of payment including documentation of clinical needs, functional status, and service utilization.

  • With promulgation of §484.250 as a condition of payment, entire home health claims are now subject to denial if agencies do not submit start-of-care and recertification assessments for every Medicare episode to the state. [Lisa’s emphasis]
  • HIPPS code on the final claim matches that received on the OASIS validation report AND OASIS data has to have been submitted prior to the final claim.

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