Wyatt Earp famously said, Fast is fine, but accuracy is everything. This adage rings true in home health billing, which sometimes feels like the wild, wild west. In running an effective agency, you may tend to focus on speed. How fast can you submit a RAP? How long will it take Medicare to pay you? How quickly can doctors sign orders? How fast can you find a temp nurse to cover a shift?
When you take the time to slow down and consider your daily activities, it’s clear accuracy plays a crucial role in success. Yet it sometimes feels easier to sacrifice accuracy for speed.
Specifically, your agency’s livelihood depends on the accuracy of your Outcome and Assessment Information Set (OASIS) practices and procedures. OASIS data collection acts as the eyes of Medicare, putting in perspective what care has or will be given to each patient and the care’s necessity. Correctly completing, submitting and updating each patient’s OASIS assessment sets the table for an accurate treatment plan, rate of reimbursement, correct care giver assignment, and later, proof of quality care.
Dangers of OASIS Inaccuracies
Your agency stands to lose money and opportunity to improve your reputation for quality care if you submit inaccurate OASIS data. If OASIS data is submitted with inaccuracies or isn’t submitted at all, CMS applies a penalty of a 2 percentage payment reduction.
As of April 1, 2017, CMS began enforcing a condition for Medicare payment that automatically checks whether the corresponding OASIS assessment is present in the Quality Information and Evaluation System (QIES). If the OASIS assessment is missing and the claim’s receipt date is more than 40 days after the assessment completion date reported on the claim, Medicare will deny your claim. The National Association for Home Care & Hospice (NAHC) reported in June that home health agencies are already experiencing increased denials related to inaccuracies since CMS began enforcing the condition.
Specifically, NACH reports that increased denials are due to a mismatch in a beneficiary’s Medicare number. Oftentimes, it’s changes in the number that occur between the time an agency submits the OASIS assessment and sends the final claim. The change is recorded in FISS and correct on the final claim but doesn’t match the OASIS assessment, triggering a denial. NAHC also reports that many times, the OASIS assessment data is in the system, but the system edit isn’t able to locate the OASIS assessment data due to the mismatch.
eSolutions’ Medicare Eligibility Verification tool, MVP Live, helps agencies avoid denials and costly appeals from discrepancies in Medicare numbers through our powerful Net Change Report. Agencies can reverify eligibility using MVP Live, and if the Net Change Report alerts you to changes in Medicare numbers, it directs you to correct mismatches and other errors on the spot.
Shoot Inaccuracies down with eSolutions OASIS Analysis
The CMS OASIS data tool is cumbersome and time consuming, which promotes entry and submission errors. eSolutions helps you eliminate OASIS assessment inaccuracies while fostering a quicker reimbursement process with our fast and powerful OASIS Analysis tool.
eSolutions OASIS Analysis works hard for you by:
Scrubbing each OASIS file to check for errors, inconsistencies and warnings in coding before submission to the QIES System. This analysis checks for, Fatal Audits, Inconsistency Flags, Diagnostic Coding Errors, Process Measure Audits and Outcome Potential
Continually tracking changes in CMS coding requirements for the most up-to-date information
Securely transmitting HIPPA-compliant files to CMS
Ensuring a quicker approval through CMS by helping you catch potential issues in patient care early
Delivering monthly automated CASPER Reports directly to your inbox so you can keep an eye on your care quality and ultimately pinpoint what improvements are needed
Don’t compromise your agency with OASIS inaccuracies. Contact the eSolutions Home Health and Hospice team of experts today to learn how you can enjoy being accurate and speedy throughout your entire billing cycle.