Today more than 50% of home health providers struggle to maintain a seamless billing transaction. When the healthcare world is becoming competitive, it becomes extremely vital for nurses and therapists to be fully well versed in the OASIS (Outcome and Assessment Information Set) in order to be properly reimbursed for all patients when it comes to managing home health billing.
Today the question that most of you ask is – What is the importance of OASIS in home health billing? And how it can affect the reimbursement?
To make your billing easy, OASIS is basically the tool that is utilized by Medicare to gather data and the necessary required information, ensuring that home health agencies deliver standardized, high-quality care to their patients.
This why initially done all by the Institute of Medicine, it is now implemented nationwide by the Centers for Medicare & Medicaid Services (CMS) as well. Also one must note that as Medicare continuously updates its requirements to address evolving circumstances, OASIS must also adapt by the home health care providers to remain compliant and profitable. Keeping up with these changes can be challenging, but it is essential for agencies seeking proper reimbursement for their services. As it not only reimbursement process, ensuring that providers receive proper payment for the skilled services they deliver but ensure a seamless billing operation. Assessing patient needs, determining payments, and maintaining compliance with Medicare regulations. In fact, to remain profitable in today’s comparative era it is important to understand the significance of OASIS, the essential documentation required for successful home health billing and best practices to maximize reimbursement.
Today many agencies use OASIS data to improve patient care, and it is also publicly reported on Medicare Care Compare. Moreover, OASIS documentation is directly tied to reimbursement, making it a critical aspect of home health billing.
OASIS data is mandatory for Medicare and Medicaid patients aged 18 years and older who are receiving skilled services such as:
– Physical therapy (PT)
– Speech-language pathology (SLP)
– Injections and wound care
Also one should know that OASIS is not required for patients receiving only personal care (e.g., bathing, dressing), homemaker services (e.g., meal preparation, grocery shopping), or chore services.
The Role of Medicare in OASIS in a home health billing
Interestingly, Medicare mandates the reporting of OASIS assessments as part of the Home Health Quality Reporting Program (HH QRP). Medicare-certified home health agencies must participate in this program, which includes two key measures that one should remember:
OASIS Data – Used to track patient progress and healthcare outcomes.
Patient Survey Results (HHCAHPS) – Measures patient satisfaction with home health services.
Medicare uses OASIS data, along with submitted claims, to evaluate outcome measures, assessing care quality from admission to discharge.
Essential Documentation for OASIS Compliance for a better home health billing:
To ensure compliance and avoid billing issues, home health agencies must include thorough documentation within OASIS. This documentation should:
Clearly support medical necessity and the need for skilled services.
Undoubtedly a face-to-face (F2F) encounter note signed by a physician, nurse practitioner or physician assistant within 90 days before or 30 days after the Start of Care (SOC).
Not to forget the outline of a Patient-Specific Plan of Care (POC) detailing interventions, medications, prognosis, frequency of services, diagnoses, mental status, and functional limitations.
Contain physician notifications and documentation if there is a delay in care initiation.
Due to the complexity of OASIS documentation, many agencies choose to outsource OASIS reviews to specialized home health billing services to ensure accuracy and compliance.
Who Can Complete an OASIS?
Since OASIS is tied to skilled services, only specific healthcare professionals can complete it:
– Registered Nurses (RN)
– Physical Therapists (PT)
– Speech-Language Pathologists (SLP)
– Occupational Therapists (OT) (for recertification, not admissions unless another discipline is ordered)
Common mistakes to avoid in OASIS for improved ROI in home health billing:
To optimize reimbursement and compliance, follow these best practices when completing OASIS documentation:
Assess the patient’s actual ability-Do not score based on what they could do, but what they can do safely.
Use human review in addition to an OASIS scrubber – Having a credentialed OASIS professional review the documentation helps ensure accuracy.
Encourage interdisciplinary collaboration – Skilled nursing, physical therapy, and other disciplines should work together to provide a comprehensive patient assessment.
Be specific with documentation – Avoid vague or generalized statements. More detailed documentation ensures accuracy and compliance.
Verify diagnoses with physician documentation – Do not rely solely on patient-reported conditions; always confirm with physician records.
Ensure the physician orders the Start of Care(SOC) date – The date should come from the physician, not patient preference.
Avoid generic Plans of Care (POC) – Patient-specific POCs are essential for ensuring the best possible care and maintaining compliance with CMS regulations.
How outsourcing can help in Home Health Billing
Providing specializing in home health billing and OASIS documentation review, there are RCM expert with extensive experience in handling complex Medicare and Medicaid billing requirements helps you with better home health billing operation. In fact, today outsourcing is the most cost effective and convenient solution to cater the large labor shortage problems and excessive wage rises.
Moreover with dedicated resources this RCM expert streamline your billing processes, ensure error-free documentation and maximize revenue potential easily.
