OASIS-Central

Q: What is the action taken when Medicare discovers an overpayment to a provider?

Q: What is the action taken when Medicare discovers an overpayment to a provider? A: When Medicare discovers an overpayment of $10 or more, they will send a demand letter requesting payment. This letter will explain the process, including interest accrual (if payment not received within 31 days of the letter date). If they receive [...]

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Is it now required that Medicare-certified agencies must complete an OASIS on all patients regardless of pay source?

Q: Is it now required that Medicare-certified agencies must complete an OASIS on all patients regardless of pay source? A: There have been no new requirements modifying Section 704 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, which temporarily suspended OASIS data collection for non-Medicare and non-Medicaid patients. While a comprehensive assessment [...]

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If the patient is discharged from Medicare and we check response 0, able to ambulate independently, in M1860, ambulation, will we set ourselves up for an audit because the patient is not homebound?

Q: If the patient is discharged from Medicare and we check response 0, able to ambulate independently, in M1860, ambulation, will we set ourselves up for an audit because the patient is not homebound? A: An agency’s goal is for patients to improve, to become as independent as possible. Given that the Centers for Medicare [...]

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If the payer source changes, do we have to do a discharge?

Q: When a current patient has a payer change to Medicare, we have to discharge the old payer and do a new start of care with Medicare as the payer. Is a discharge OASIS required for the first admission? We aren’t really discharging the patient, only the payer. A: If the initial payer is Medicare, [...]

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Best Practice vs. Covered service

As you review the OASIS-C data set questions encouraging agencies to implement EBP for diabetic foot care, you may find yourself asking a question. Will Medicare cover diabetic foot care performed by a nurse, assuming that all other Medicare coverage criteria are met? Many agencies have a policy mandating that a registered nurse perform foot [...]

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Can our agency bill Medicare for one skilled nursing visit to administer the flu vaccine if the patient is currently active and we get a physician’s order?

Q: Can our agency bill Medicare for one skilled nursing visit to administer the flu vaccine if the patient is currently active, receiving other skilled services, and we get a physician’s order? A: In 2002, the Centers for Medicare and Medicaid Services (CMS) determined it was not necessary for an agency to obtain orders to [...]

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