If care provided by the home health agency is billed to the Medicare Administrative Contractor (MAC) as traditional fee-for-service Medicare (M0150 #1) or billed to a State Medicaid Agency as traditional fee-for-service Medicaid (M0150 #3), OASIS data collection is required. Likewise, if care provided by the home health agency is billed to an insurance company who has contracted with the Federal Agency (Medicare managed care – M0150 #2) or State Medicaid Agency (Medicaid managed care– M0150 #4), to pay for home health services with Federal Medicare or State Medicaid funds as a managed care plan, OASIS data collection is required.
Full Answer
What is the m0150 form?
M0150, Current Payer Sources, is asking for identification and reporting of any payers the agency plans to bill for services during this episode of care. When a Medicare patient is admitted for home care services under a private insurer and the Medicare eligibility criteria are met, Medicare is always a likely payer and may be included in M0150.
What is the notice of Medicare non-coverage?
A Medicare health provider must give an advance, completed copy of the Notice of Medicare Non-Coverage (NOMNC) to enrollees receiving skilled nursing, home health (including psychiatric home health), or comprehensive outpatient rehabilitation facility services, no later than two days before the termination of services.
What is an example of a non covered service under Medicare?
For example, a 67-year-old established patient presents for a covered service, such as an office visit for a chronic illness (e.g., 99213). At the same encounter, the patient chooses to receive a preventive medicine examination (e.g., 99397), which is a non-covered service under Medicare.
What is the appropriate m0150 response for an auto accident?
CMS Q&A Category 4b Q24 states that if a patient is involved in an auto accident the M0150 response should be 1 or 2 as appropriate for that patient. Would we also pick response 11 - Other and enter auto insurance or UK - Unknown?
What is M0150?
M0150 identifies the payers to which any services provided during the home care episode are being billed.
What is an oasis assessment?
The Outcome and Assessment Information Set (OASIS) is a comprehensive assessment designed to collect information on nearly 100 items related to a home care recipient's demographic information, clinical status, functional status, and service needs (Centers for Medicare and Medicaid Services [CMS], 2009a).
Who is qualified to collect the Oasis data?
1. CMS defines a qualified clinician for the purpose of collecting and documenting accurate OASIS data as a Registered Nurse, Physical Therapist, Speech-Language Pathologist, or Occupational Therapist.
Which of the following situations would require an oasis assessment?
Currently, OASIS requirements apply to all patients receiving skilled care reimbursed by Medicare, Medicaid, and Medicare or Medicaid managed care patients with the following exceptions: patients under the age of 18, patients receiving maternity services, patients receiving only chore or housekeeping services, and ...
What are Oasis process measures?
Assessment-based measures OASIS-based process measures are not risk-adjusted show how often home health agencies gave recommended care or treatments that research shows get the best results for most patients. OASIS-based outcome measures are risk adjusted using available OASIS-based data elements.
What is the MDS assessment?
Description: The Long Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status which forms the foundation of the comprehensive assessment for all residents of long-term care facilities certified to participate in Medicare or Medicaid.
Who completes the discharge Oasis?
How do we complete the OASIS discharge? ANSWER 2: In the case of an unplanned or unexpected discharge (an end of home care where no in-home visit can be made), the last qualified clinician who saw the patient may complete the discharge comprehensive assessment document based on information from his/her last visit.
What is a transfer oasis?
Centers for Medicare & Medicaid Services. OASIS ITEM. (M1850) Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast.
What are the two important purposes of the Outcome and assessment information set Oasis?
The Outcome and Assessment Information Set (OASIS) is a group of standard data elements designed to enable systematic comparative measurement of home health care patient outcomes at two points in time in adult skilled Medicare and Medicaid, non-maternity home health care patients.
Which assessment should be performed during the patient's initial visit to a new health care provider quizlet?
Comprehensive - A comprehensive assessment should be completed upon admission to a healthcare facility or during the first visit with a new health care provider. A nurse enters a patient room to assess the patient's blood pressure, temperature, pulse, and pain.
Is the oasis the comprehensive assessment?
The comprehensive assessment, which includes OASIS items for Medicare and Medicaid patients, must be updated and revised as frequently as the patient's condition requires, but not less frequently than every 60 days beginning with the start of care date; within 48 hours of the patient's return home from an inpatient ...
How do you fill out an oasis?
3:266:19OASIS Basics: How to Start a New Home Health Patient - YouTubeYouTubeStart of suggested clipEnd of suggested clipBut you should call your agency before proceeding. Further. Once you start your Oasis assessmentMoreBut you should call your agency before proceeding. Further. Once you start your Oasis assessment with a valid mu 30 date. This now sets that the last day for MU 90 date the assessment is completed.
How long after start of care is the Oasis assessment required?
A31. The Start of Care OASIS items, which must be integrated into your agency's own comprehensive assessment, must be completed in a timely manner, but no later than five calendar days after the start of care date. The comprehensive assessment is not required to be completed on the initial visit; however, agencies may do so if they choose.
What is day 60 in a hospital discharge?
hospital discharge may occur on day 60 or day 61 and the HHA performs a Resumption of Care assessment which DOES NOT change the HIPPS code from a recertification assessment performed in the last 5 days (days 56-60) of the previous episode. In this case, home care would be considered continuous if the HHA did not discharge the patient during the previous episode. (Medicare claims processing systems permit “same-day transfers” among providers.) The RAP for the episode beginning after the hospital discharge would be submitted with claim “from” and “through” dates in FL 6 reflected day 61. The RAP would not report a new admission date in FL 17. The HIPPS code submitted on the RAP would reflect the recertification OASIS assessment performed before the beneficiary’s admission to the hospital. This OASIS assessment would also be reflected in the claims-OASIS matching key in FL 63. This OASIS assessment would be submitted to the OASIS system, as would the Resumption of Care assessment.
When is a beneficiary hospitalized?
beneficiary may be hospitalized in the first days of an episode, prior to receiving home health services in the new episode . These cases are handled for billing and OASIS identically to cases in which the beneficiary was discharged on days 60 or 61. If the HIPPS code resulting from the Resumption of Care OASIS assessment is the same as the HIPPS code resulting from the recertification assessment, the episode may be billed as continuous care. If the HIPPS code changes, the episode may not be billed as continuous care. The basic principle underlying these examples is that the key to determining if episodes of care are considered continuous is whether or not services are provided in the later episode under the recertification assessment performed at the close of the earlier episode.
Does Medicare cover exceptions?
This booklet outlines the 4 categories of items and services Medicare doesn’t cover and exceptions (items and services Medicare may cover). This material isn’t an all-inclusive list of items and services Medicare may or may not cover.
Does Medicare cover personal comfort items?
Medicare doesn’t cover personal comfort items because these items don’t meaningfully contribute to treating a patient’s illness or injury or the functioning of a malformed body member. Some examples of personal comfort items include:
Does Medicare cover non-physician services?
Medicare normally excludes coverage for non-physician services to Part A or Part B hospital inpatients unless those services are provided either directly by the hospital/SNF or under an arrangement that the hospital/SNF makes with an outside source.
Does Medicare cover dental care?
Medicare doesn’t cover items and services for the care, treatment, filling, removal, or replacement of teeth or the structures directly supporting the teeth, such as preparing the mouth for dentures, or removing diseased teeth in an infected jaw. The structures directly supporting the teeth are the periodontium, including:
Can you transfer financial liability to a patient?
To transfer potential financial liability to the patient, you must give written notice to a Fee-for-Service Medicare patient before furnishing items or services Medicare usually covers but you don’ t expect them to pay in a specific instance for certain reasons, such as no medical necessity .
What is an ABN for Medicare?
If a Medicare patient wishes to receive services that may not be considered medically reasonable and necessary, or you feel Medicare may deny the service for another reason, you should obtain the patient’s signature on an Advance Beneficiary Notice (ABN).
When Medicare or another payer designates a service as “bundled,” does it make separate payment for the pieces of the
When Medicare or another payer designates a service as “bundled,” it does not make separate payment for the pieces of the bundled service and does not permit you to bill the patient for it since the payer considers payment to already be included in payment for another service that it does cover. Coordination of Benefits.
What does the -GX modifier mean?
The -GX modifier indicates you provided the notice to the beneficiary that the service was voluntary and likely not a covered service. -GY – Item or service statutorily excluded, does not meet the definition of any Medicare benefit or for non-Medicare insurers, and is not a contract benefit.
What are non covered services?
Medicare Non-covered Services. There are two main categories of services which a physician may not be paid by Medicare: Services not deemed medically reasonable and necessary. Non-covered services. In some instances, Medicare rules allow a physician to bill the patient for services in these categories. Understanding these rules and how ...
Is it reasonable to ask for a service from Medicare?
Medically Reasonable and Necessary. A patient may ask for a service that Medicare does not consider medically reasonable and necessary under the circumstances. For instance, the patient wants the service more frequently than Medicare allows or for a diagnosis that Medicare does not cover.
Do commercial insurance companies have similar coverage guidelines?
Commercial insurance companies and some Medicaid payers will have similar types of information about their coverage guidelines on their websites. Stay up-to-date on these policies for your local payers to ensure claims are processed as medically reasonable and necessary.
Can you bill for a non-covered medical visit?
For instance, in the case of a medically-necessary visit on the same occasion as a preventiv e medicine visit, you may bill for the non-covered (carved-out) preventive visit, but must subtract your charge for the covered service from your charge for the non-covered service.
What happens when the MSP effective date is not correct?
When this happens, the contractor shall advise the COB, via ECRS, of the need to change the MSP effective date and shall provide the COBC with documentation to substantiate the change.
What is the MSP Auxiliary File number?
As a result of MSP litigation settlement agreements CMS negotiated, records were added to the MSP Auxiliary file under contractor number 33333 (litigation settlement). Under the settlement agreements, CMS was to receive records for only those Medicare beneficiaries for which Medicare was secondary payer per a settlement agreement However, some data provided to CMS contain records for Medicare beneficiaries covered under a retirement group health plan or supplemental plan. These records were added to the CWF, MSP Auxiliary File. As these erroneous records are identified, beneficiaries, providers and the primary health plan have been notifying contractors that the records need to be corrected to again reflect Medicare as primary. All MSP Auxiliary File records, including these litigation records, need to be corrected and complete to maintain the integrity of the MSP Auxiliary File. As they become aware of an erroneous record, intermediaries and carriers are to advise the COBC via ECRS.
What is the DX code for fractures?
Fractures are currently identified in the 800-829 DX code range. Codes within the 800 - 804 category (Fracture of Skull) are not related to codes within the 805 - 809 category (Fracture of the Neck and Trunk). For instance, if a beneficiary CWF MSP auxiliary record contains a DX code 800.2, but an 806.1 DX code is received on an incoming claim, CWF and the contractor shall not assume that the 806.1 DX code is related to the 800.2 DX code on the MSP record. Development actions by the contractor are required in this situation. Following are a few more specific examples:
How many MSP records can be stored in CWF?
maximum number of 17 MSP auxiliary records may be stored in CWF for each beneficiary. The COBC is responsible for deletion of a record when the maximum storage is exceeded using the following priority:
Do non-lead contractors need to respond to ICN requests?
Non-lead contractors do not need to respond to ICN requests sent within the 18-month period. They should annotate such ICNs with the reason the ICN is not being processed and immediately return the ICN to the lead contractor (to ensure that the lead contractor can obtain the information from CWF while it is still available). If a non-lead contractor experiences repeated problems with this issue from a particular lead contractor, they should notify their regional office (RO).
Is 930 code related to 934?
For instance, all codes within category 930 (930.0 - 930.9) shall assume to be related; however, codes within category 934 (934.0 - 934.9) shall assume to be unrelated to the 930 category DX codes.
Can a beneficiary have MSP?
An MSP situation cannot exist when a beneficiary has GHP coverage (i.e., working aged, disability and ESRD) and is entitled to Part B only. CWF will edit to prevent the posting of these MSP records to CWF when there is no Part A entitlement date. Currently, if a contractor submits an Electronic Correspondence Referral System (ECRS) transaction to the coordination of benefits (COB) contractor to add a GHP MSP record where there is no Part A entitlement, the contractor will receive a reason code of 61. The COB contractor's system cannot delete these types of records once the records are posted to CWF by a contractor. Beginning April 2002 CWF will create a utility to retroactively delete all MSP GHP records where there is no Part A entitlement.