Outcome Assessment
Information Set (OASIS) Update
PDF Version
of BQA 00-075 (PDF, 28 KB) - includes attachments
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Date: November 14, 2000 DSL-BQA-00-075
To: Home Health Agencies HHA 32
From: Jan Eakins, Chief, Provider Regulation & Quality
Improvement Section
cc: Sue Schroeder, Director, Bureau of Quality Assurance
The purpose of this memorandum is to provide information related to the
federal Outcome ASsessment Information Set (OASIS).
Faxing OASIS Information
The attached memorandum from the federal
Health Care Financing Administration provides guidance to home health agencies (HHAs)
concerning faxed transmission of OASIS data. HHAs must follow the guidelines identified in
this memorandum to ensure confidentiality of all patient identifiable information. For
questions regarding these faxing procedures, agencies may contact Andrea Henrich, (608)
267-3807 or Chris Benesh, (608) 266-1718.
Revised Policy for Transmitting OASIS Data
Effective October 1, 2000, HHAs must encode and transmit OASIS data to
the State OASIS System on all Medicare/Medicaid patients receiving skilled care,
regardless of who pays for that skilled care, if Medicare or Medicaid reimburses for
any
home health provided service.
The collection of OASIS is required for all skilled HHA patients. OASIS item M0150
identifies payers to which any service provided during the home care episode is
being billed. Any time M0150 is coded as 1, 2, 3, or 4 for any service, including
home health aide, OASIS data must be collected, encoded, and transmitted.
For example: The HHA must collect, encode and transmit OASIS data on a patient who is
receiving skilled nursing or therapy services paid by a private insurance payer and home
health aide services paid by Medicare or Medicaid.
Prior to implementation of the Medicare prospective payment system (PPS), HHAs were
instructed only to encode and transmit OASIS data collected on patients whose skilled
services were reimbursed by Medicare or Medicaid.
This new policy may change how some agencies transmit OASIS records. HHAs that
previously were not encoding and transmitting OASIS records for skilled patients with only
non-skilled services paid by Medicare/Medicaid must submit these records, starting with
all assessments that have a completion date on or after 10/01/2000.
Encryption
Effective 10/1/2000 HCFA implemented 128-bit encryption for OASIS data
that is transmitted to the State OASIS System. HHAs have previously been informed to
update their web browser (Internet Explorer or Netscape) to be compatible with 128-bit
encryption. Agencies that do not conform to this new standard will not be able to transmit
OASIS data to the State OASIS System and will receive an error that they are not
authorized to view the OASIS web page.
Netscape Navigator version 4.08 is compatible with 128-bit encryption and HHAs may
download this web browser from the State OASIS System. The Netscape Navigator file that is
downloaded is an executable file that must be installed after the download is completed.
Installation instructions are also available on the State OASIS System.
Updated HCFA OASIS Home Page
HCFA has updated their Home Page. Access this website at:
www.hcfa.gov/medicaid/oasis/oasishmp.htm
[replaced by www.cms.hhs.gov/oasis
(exit DHFS)]
and click on "What’s New" for information on the
following:
-
OASIS Item-by-Item Tips: Revisions to the Item-by-Item Tips found in Chapter 8 of the
OASIS User’s Manual.
-
OASIS B-1 (8/2000) Data Set: Version of OASIS data set in effect since September 1,
2000.
-
OASIS and PPS: Overview of collection and reporting of OASIS data for Medicare
reimbursement under the new payment system.
-
OASIS Considerations for Medicare PPS Patients: Hints to help HHAs integrate PPS into
their OASIS procedures.
-
OASIS Recertification Assessment Scheduling Calendar: Perpetual calendar to assist HHAs
in scheduling OASIS follow-up assessments within the required 5-day certification window.
Bulletins
The OASIS Welcome Page on the State OASIS System includes a Bulletins
area that contains information related to OASIS collection, encoding, submission, and PPS.
HHAs are encouraged to check this site periodically to keep current on OASIS. Several
files that are posted on this site require Adobe Acrobate Reader software to view the
information. HHAs can download Adobe Acrobate Reader software from the following Internet
site: http://www.adobe.com/products/acrobat/readermain.html
(exit DHFS)
HHA Web Reports
Web Reports are now available from the State OASIS System and can be
found by selecting HHA Web Reports located on the OASIS Welcome Page. Agencies are
required to download a Report Viewer Plug-In file the first time reports are accessed. A
variety of reports are available and can be used by a HHA to assure the accuracy and
timeliness of OASIS submissions. Chapter 4 of the Home Health Agency System User’s
Guide provides information on the content of each report. The entire System User’s
Guide is available under the Bulletins area of the State OASIS System.
OASIS Item M0825
OASIS item M0825 (Therapy Need) indicates the need for therapy
(physical, occupational, or speech therapy) during the home health episode. This item,
which identifies high therapy use, must be coded correctly to obtain a Health Insurance
Prospective Payment System (HIPPS) code for Medicare payment. HHAs must respond with
"no" or "yes" to M0825 for all assessments that will be used for
Medicare PPS.
Responses to M0825:
-
Response 0 (No) indicates that the patient requires no therapy services or less than 10
therapy visits within the 60-day episode of care.
-
Response 1 (Yes) indicates that the patient requires 10 or more therapy visits within
the 60-day episode of care. (Include the cumulative total of therapy visits for OT, PT,
and ST.)
-
Response NA (Not Applicable) is used for all non-Medicare patients.
-
Response NA (Not Applicable) may also be appropriate for Medicare patients for whom the
assessment will not be used to determine a Medicare episode payment. For example:
M0825 could be NA (Not Applicable) for Medicare PPS patients if the patient returns
home from an inpatient stay within the 60-day episode and the Resumption of Care
assessment indicates no change in current case mix. If the assessment is not going to be
grouped for billing purposes, then M0825 should be NA.
VERSION_CD2
The OASIS data specifications includes a version control mechanism which
allows records with M0090_INFO_COMPLETED_DT in September to be edited using version 1.04
or 1.10 data specifications. The VERSION_CD2 field drives the version control. The State
OASIS System looks at this field first to determine which data specifications will be
utilized to edit the record. To be edited using the current 1.10 data specifications, a
record must have '01.10' in the VERSION_CD2 field. Anything other than this, i.e., '1.10 '
will be edited using the 1.04 data specifications.
VERSION_CD2 has always been a five-digit field. With v1.04 of the data specifications,
the incoming VERSION_CD2 was '1.04 '. The VERSION_CD2 for version 1.10 uses a leading 0
without a space, '01.10'. Several vendors overlooked this format change. When an incoming
record has '1.10 ' in the VERSION_CD2 field, the system will issue warning message 235,
'Inconsistent version number' (the only allowable version number is 1.04). Then, because
the system is editing for v1.04, a VERSION_CD1 (OASIS version) response of B1-0800 will
produce fatal record error 213, 'Invalid data value' (VERSION_CD1 should be B1-1098 for
v1.04, not B1-0800). If this error occurs, agencies need to ask their software vendors to
make the necessary coding change to the VERSION_CD2 field, and then resubmit.
Records with M0090_INFO_COMPLETED_DT prior to September 1, 2000 will be edited using
v1.04 data specifications. Records with M0090_INFO_COMPLETED_DT of October 1, 2000 or
later will automatically be edited using the v01.10 data specifications.
PPS Information
Information on PPS can be accessed at the following websites:
-
www.hcfa.gov/medicare/hhmain.htm [replaced by www.cms.hhs.gov/providers/hhapps/
(exit DHFS)] (look under home health PPS final rule)
-
www.hcfa.gov/medicaid/oasis/oasishmp.htm [replaced by www.cms.hhs.gov/oasis
(exit DHFS)] (click on "What’s New")
-
www.ugsmedicare.com/pdf/all_providers/home_
health_pps_questions_and_answers.doc
[Link no longer operable]
FAQs
Q. When I try to access the State OASIS System using the
AT&T Global Network Dialer, I receive a message that says "You are not allowed to
access a line with an analog surcharge." What should I do?
A. This message will appear if your HHA has not been given authorization
from MDCN to use the toll free 1-800 number. HHAs should check for a local phone number in
the AT&T Global Network Dialer software. If a local phone number is not available,
contact MDCN at 1-800-905-2069 to request approval to use the 1-800 number.
Q. What do I need to do to correct fatal record error message 255 that
indicates inconsistent M0175/M0200/M0220 values?
A. This message generally is the result of incorrect coding of M0220 for
patients that have not had an inpatient facility stay in the past 14 days and have not had
a medical or treatment regimen change within the past 14 days. Use the following coding
guidelines when answering M0175, M0200 and M0220 for these patients:
-
If "M0175 – From which of the following Inpatient Facilities was the patient
discharged during the past 14 days?" is coded as "NA-Patient was not discharged
from an inpatient facility;"
-
And "M0200 – Medical or Treatment Regimen Change Within past 14 Days." is
coded as "0-No;"
-
Then "M0220 – Conditions Prior to Medical or Treatment Regimen change or
Inpatient Stay Within Past 14 Days" must be coded as "NA-No inpatient facility
discharge and no change in past 14 days." M0220 should not be coded as
"7-None of the above."
Q. Is it necessary to complete a discharge assessment for a patient who
is discharged after a hospital stay?
A. The patient who is discharged after a hospital stay will have had
OASIS data reported at the point of transfer to the inpatient facility. No additional
assessments or OASIS data collections are expected in this situation unless a resumption
of care occurs. Therefore, the agency will complete a "paper discharge" in their
records, but no OASIS data are reported.
Q. Can we discharge a client who is in the hospital beyond the 60-day
certification period? What information do we use to complete the discharge OASIS?
A. The HHA should discharge a patient who remains in the hospital beyond
day 60 of an episode. If the transfer OASIS assessment was completed on admission to the
hospital, no further OASIS assessments are needed.
Q. If the only service provided to a patient is medication management
reimbursed by Medicaid, is the HHA required to collect, encode and transmit OASIS data?
A. The requirement to collect, encode and transmit OASIS data applies to
all Medicare/Medicaid patients receiving skilled care. The definition of skilled care
depends on the service provided, not the level of reimbursement. Since medication
management requires the skills of a nurse, a HHA must meet the OASIS requirements for a
patient receiving this service.
Q. With PPS requirements, what are HHAs who don’t offer therapy
services expected to do if a patient is admitted with a diagnosis requiring a therapy
service?
A. Under the consolidated billing requirements of the Home Health PPS,
HHAs are expected to provide the therapy or arrange for it. If they choose to provide
these new services (i.e., physical therapy, occupational therapy or speech language
services), they must notify the State Survey Agency and their Regional Home Health
Intermediary. The HHA may either provide them directly or "under arrangement,"
according to the State Operations Manual section 2180.
Q. What if a patient is referred to an HHA that is not able to either
provide or arrange for a needed therapy service?
A. If the agency is not able to provide these services, the HHA should
advise the patient on admission of the extent of its current services. If a patient
needing therapy services is referred to an HHA that does not provide these services, the
options are:
-
The agency should not accept the patient if it cannot meet all his/her needs;
-
The patient should be advised that the agency does not provide therapy services and the
patient can elect to go to another HHA that provides therapy services; or
-
The patient can decline the therapy services and receive only the other ordered HHA
services. The MD must be notified if the HHA can not meet the patient’s need for
therapy services or the patient refuses the ordered therapy service.
Q. Why is the OASIS record rejected by the State when I use an AIDS
diagnosis code as the primary diagnosis for OASIS item M0230?
A. To protect patient confidentiality, regulations in 16 states,
including Wisconsin, do not allow the transmission of HIV, AIDS or STD diagnoses as the
primary diagnosis in OASIS item M0230. All HIV, AIDS or STD diagnoses codes that are
transmitted in an OASIS record are removed by the State OASIS System before the record is
validated. For this reason, when HIV, AIDS or STD codes are listed as the primary
diagnosis, a fatal record message is generated indicating that the (M0230) Primary
Diagnosis field cannot be blank, because the record appears to not contain a primary
diagnosis.
To permit transmission of the record, the HHA should contact the patient’s
physician to determine a specific diagnosis for which the patient is being treated or use
a secondary or "next best" diagnosis for the primary reason you are providing
services.
State Help
Questions related to software and OASIS data transmission (connection,
feedback reports, fatal records, error messages, and data corrections) should be direct to
either:
or
Questions related to OASIS data collection (clinical issues) should be directed to:
General home health questions should be directed to:
-
Barbara Woodford, Home Health/Hospice Nurse Consultant
[replaced by Marianne
Missfeldt, (715) 836-4036, 10/03]
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