OASIS claims payment reference is here!

On Oct. 20, I posted about how OASIS claims are required for payment. I have received several queries about where the source information can be found. Look below for the answers!

The Federal Register, November 2009 (http://edocket.access.gpo.gov/2009/pdf/E9-26503.pdf) explains: “Rather, we intend that in finalizing this policy, providers will ensure that prior to submitting a final HH PPS episode claim, a provider will have submitted an OASIS, and the HIPPS code on the final HH PPS episode claim will be consistent with the HIPPS on the OASIS validation report. As such, we are implementing the provision to require the submission of OASIS for final claims as a condition of payment, and revising § 484.210”

This pertains to HH PPS claims and Medicare HMOs will most likely have their own requirements.
This information comes from Category 1 Question 1 from CMS(updated 09/09):The comprehensive assessment must include OASIS items for all skilled Medicare, Medicaid, and Medicare or Medicaid managed care patients with the following exceptions: patients under the age of 18, patients receiving maternity services, patients receiving only chore or housekeeping services, and patients receiving only a single visit in a quality episode. The transmission requirement currently applies to Medicare and Medicaid patients receiving skilled care only.

One Comment to “OASIS claims payment reference is here!”

  1. Great information! We are so happly you help us see through the woods of the forest 🙂

    AR Consultants
    Patty Lopez

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