Getting an accurate and timely OASIS is a challenge that home health providers continue to face. As providers continue to gear up for OASIS-E, it will be important to follow a set of processes that will help set them up for success.
“We’ve got to be thinking about how we can make this better,” Cindy Krafft, co-owner and co-founder of consulting firm Kornetti & Krafft Health Care Solutions, said earlier this month during a presentation at the annual Illinois HomeCare & Hospice Council (IHHC) conference. “I think OASIS-E is going to be a great place to start. A great place to say, however we did it before, how can we do better going forward?”
Broadly, the implementation of OASIS-E comes after public health emergency-related delays. OASIS-E is set to be implemented on Jan. 1, 2023, in order to line up with the start of the nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model.
Since payment and outcomes for providers are directly impacted by OASIS data collection, it’s crucial that the data accurately reflects the status of the patient.
Thus, intake has a major impact on getting a clean and speedy OASIS.
During intake there are several key questions to be considered, according to Krafft: Which physician will provide the face-to-face encounter for the patient’s home health services?; What is included in the face-to-face documentation to support services for the patient?; What additional information should be requested to support eligibility for the patient’s care?; What must you ensure is provided in the referral order for services?
Providers should remember that physicians are responsible for diagnosis assignment.
“As a clinician in the home, I can’t put in a diagnosis of diabetes, just because the patient says, ‘Honey, I got problems with the sugars,’” Krafft said. “What the patient told you is food for thought, but you need to go back to the physician and figure out if this is accurate or not. We can’t just take their word for it.”
Krafft also noted that the lack of consistent physician documentation to support secondaries slows down the coding process.
“I’ve seen from our coders where work has to stop, and you have to go back to the client with, ‘You don’t have adequate position documentation for the secondary, or there’s things mentioned in these documents that are not showing up in clinician lists,’” she said. “By the time it’s already reached the coder — how do we get this far without physician-signed documents?”
When it comes to coding, providers need to move away from the idea that coding errors only count if it affects reimbursement.
Sometimes providers will not be able to find an OASIS item for every piece of information that will be gathered about a patient. In those cases, they should choose the best fit from what is available, according to Krafft.
Ultimately, accountability will be the key with OASIS-E.
“Part of this has a lot to do with accountability,” Krafft said. “We have to make sure there are clear expectations about what we’re saying is an error and what isn’t an error.”
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