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June 12, 2017

Prevent Denials Due to OASIS Assessment Not Matching

As implemented in Change Request 9585, final claims submitted with dates of service on or after April 1, 2017, will deny when the Outcome and Assessment Information Set (OASIS) assessment has not been submitted timely. The Home Health and Hospice Provider Contact Center (PCC) continues to receive calls regarding this requirement. To avoid denials, prior to submission of the OASIS assessment and the final claim, ensure the following OASIS items are correct. These items are used to match the claim with the OASIS assessment.

  • Home health agency (HHA) Certification Number (OASIS item M0010)
  • Beneficiary Medicare Number (OASIS item M0063)
  • Assessment Completion Date (OASIS item M0090)
  • Reason for Assessment (OASIS Item M0100) equal to 01, 03, or 04

In addition, before submitting the final claim, it is important that you ensure the OASIS assessment has completed processing and was successfully accepted into the Quality Information and Evaluation System (QIES) National Database. Verify this by reviewing the OASIS Agency Final Validation Report or OASIS Submitter Final Validation Report for the submission which included the assessment. These reports will provide information that confirms the assessment's receipt, the date of receipt, and any fatal or warning errors encountered.

For additional information, refer to the following resources:

  • MM9585External PDF – Denial of Home Health Payments When Required Patient Assessment Is Not Received
  • SE17009External PDF – Denial of Home Health Payments When Required Patient Assessment Is Not Received – Additional Information

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