July 20, 2017

Navigating that OASIS C2 Denial


Navigating the OASIS C2

As of April 1, 2017, Medicare began automatically denying claims with missing patient assessment data in the OASIS. Agencies are scratching their heads over the new denials. With some, they just plain messed up. The OASIS was not transmitted before the final claim for the episode was transmitted. With some, OASIS was submitted in time, but certain data was wrong or missing. In some cases, however, it is difficult to figure out what went wrong.
The CoPs require that OASIS be transmitted within 30 days of completion (M0090 date). If the OASIS assessment is not found and the receipt date of the claim is more than 30 days after the assessment completion date on the claims, Medicare will deny the claim. Initial implementation allows for 40 days.
The system will check to see whether the OASIS has been completed and accepted into the QIES database (that’s where the OASIS goes, hopefully, when transmitted). The claim will be denied if the assessment is missing AND past due. Medicare will have the Group Code of CO and Claim Adjustment Reason Code 272 on the denial.
Any errors encountered during submission should be evaluated so that it doesn’t happen again.
These four M0 items are checked by the system, so ensure they are complete. These items will be used to match claims and assessments:

HHA CMS Certification Number (OASIS item M0010)
Beneficiary Medicare Number (OASIS item M0063)
Assessment Completion Date (OASIS item M0090)
Reason for Assessment (OASIS item M0100) equals to 01, 03, or 04 (Start of Care, Resumption of Care and Recertification).

The Medicare number is a common reason for denial. NAHC is working with CMS to encourage the use of some other identifier since the letter changes based on marital status.
Other problems include blanks in the OASIS data, wrong assessments, and untimely assessments. Selman-Holman & Associates has been evaluating the different reasons for denials to determine the best course of action.
First action: These denials can be appealed. The first step is to check the OASIS Agency Final Validation Report and OASIS Submitter Final Validation Report to confirm that the assessment was transmitted AND accepted. If it is not there, figure out what went wrong.
Second action: Prior to submitting claims, check the OASIS Agency Final Validation Report or OASIS Submitter Final Validation Report for the OASIS that goes with the claim. Do not transmit a final claim for the episode if the OASIS has not been accepted. You can still fix errors after the 40 days. Accuracy is important. Denials happen when missing AND past due.

Best action: Contact the Selman-Holman & Associates, LLC Denials Management Team for any assistance with ADRs, appeals and other audits. Call Diane at 214-550-1477 or email your inquiry to Diane@selmanholman.com.

July 3, 2017

Happy 4th of July!



“I like to see a man proud of the place in which he lives. I like to see a man live so that his place will be proud of him.” ~Abraham Lincoln

 Selman Holman & Associates would like to wish all of you a spectacular Independence Day! As we celebrate this great nation, lets take time to truly appreciate our homeland and show gratitude for all she provides. Whether you are celebrating this day with fireworks, BBQs, or simply a day off from work, enjoy your time and take this opportunity to reflect on what a exceptional country we are celebrating. We are privileged to call these United States home.

Happy 4th of July everyone and God Bless America!

June 28, 2017

Always Look for the Expiration Date

Beginning June 21, 2017, home health and hospice providers should have started using the renewed Fee for Service, Advanced Beneficiary Notice of Noncoverage, form CMS-R-131.

FFS ABN will be utilized in the event Medicare is expected to deny care.

Although there are no changes to the form itself, providers should be aware that there is a newly incorporated expiration date of 3/2020.  Besides the expiration date, the ABN has also been revised to include information to the beneficiaries of their rights to CMS nondiscrimination practices and how to obtain the ABN in an alternative format if needed.

The form, along with the form instructions, can be found at this link:


June 7, 2017

Summer Equals Melanoma Awareness

Skin cancer is the most common type of cancer in the United States. UV radiation from the sun, tanning beds or sun lamps can lead to melanoma, the most dangerous form of skin cancer. 3.5 million people are diagnosed each year with some form of skin cancer and men over 50 have an increased risk of developing melanoma compared to the general population. Women…keep an eye on your man. Studies show that women are nine times more likely than men to notice melanoma on others.

Shedding some light on tanning beds:
Brazil and Australia have banned indoor tanning completely. Those who have tanned indoors have a 69% higher risk of developing basal cell carcinoma before age 40. People who first used a tanning bed before the age of 35 increase their risk for melanoma by 75%. 12 states have banned the use of tanning beds by anyone under 18.

Not all moles are created equal. A normal mole should be symmetrical. If you notice spots on your body that seem to change in diameter or color, make an appointment with a dermatologist immediately.

Although sun provides us with an excellent source of vitamin D, too much is not a good thing. 90% of skin aging is caused by the sun. Protecting yourself from harmful UV rays on a daily basis with a sunscreen with SPF 15 or higher, reduces your risk by 50%.
So, slather on the sunscreen and don’t forget your hat this summer as you enjoy life’s natural rays.

May 26, 2017

Honoring Memorial Day

On Monday the 29th, the flag of our country will be quickly raised to the top of the staff then solemnly lowered to half-staff position and will remain there only until noon. Then it will rise again to full-staff for the remainder of the day.

The half-staff position remembers those who gave their lives in service of our country. At noon, their memory is raised by the living, who resolve not to let their sacrifice be in vain.

Memorial Day is the unofficial beginning of summer, with Labor Day indicating the end.

Memorial Day is often confused with Veterans Day. Memorial Day honors those military men and women who have died while defending our country and Veterans Day celebrates all service members.

While many of us view this day as a day-off from work, connected to picnics and parades, it is truly a day of remembrance to those who gave their greatest gift for our greatest gift…freedom.


God bless America and those who gave their lives for her.