OASIS mistakes that sink claims

This past September, I had the opportunity to attend the National Quality Outcomes and OASIS-C conference presented by Decision Health. It was my first time attending this conference and I was very impressed with the speakers and the presentations. The presenters were from various home health agencies and consulting groups throughout the country. The topics included many different aspects of home health documentation including OASIS assessment accuracy, supportive documentation and improvement of outcomes.

One presentation which stands out included the “top ten OASIS mistakes that sink claims”.

1. G-code compliance-Does every visit support G-code reporting?

2. Near LUPA episodes-How many episodes are 5 or 6 visits- May suggest that agencies are trying to maximize revenue
focusing on medical necessity or quality? National average for LUPA is 6-10%

3. Skilled therapy– Are all therapy visits necessary and is progress toward goals documented on every visit?

4. OASIS submission error-286 Are OASIS assessments submitted within 30 days?

5. OASIS submission error-262 M0090 is within CMS guidelines (no earlier than day 56 and no greater than day 60)?

6. Sources of Assistance-How does interdisciplinary documentation support OASIS scoring? Item M2100 items answers must
match clinical documentation of need and skill provided.

7. Oral medications-Red flags and risks: Definition of independence; New or Changed not identified on POC;  Medication
lists updated; no response to teaching documented.
Injectable medications: Are you under reporting patients who have injectable medications? This often occurs with
Diabetes and Anemia.

8. Ambulation-Documentation does not support ambulation scoring: willingness and compliance are not the focus; check boxes
can lead to mistakes; definition of independence. M1860 responses and some diagnoses can impact reimbursement.

9. Fall Risk Assessment-documentation does not support fall risk.

10. Patient condition= Case Mix: Is the Case-mix acurrate and congruent with the documented patient condition?

Although this information is well known to all of us, it is always good to brush up on regulations and requirements.

Until next time,

M

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