CMS Requests Approval For The OASIS C1/ICD-10 Data Item Set

CMS is requesting approval by the Office of Management and Budget (OMB) for an Outcome and Assessment Information Set (OASIS) data set to accommodate the International Classification of Diseases (ICD)-10. The newest version of the OASIS is referred to as the OASIS C1/ICD-10 data item set.

The OASIS-C1 data item set could not be implemented on October 1, 2014 due to the Protecting Access to Medicare Act of 2014 (PAMA) being enacted. PAMA prohibited the Secretary from adopting ICD-10 prior to October 1, 2015. Since ICD-10 had been delayed until October 1, 2015, CMS made interim changes to the OASIS-C1 data item set to accommodate the continuation of the ICD-9 diagnosis codes. Five of the data items which used ICD-10 codes were modified.  The current version of the data item set for OASIS-C1/ICD-9 is still in use until the implementation of ICD-10.

The OASIS C-1/ICD-10 version replaces the five items that were modified in the OASIS C1/ICD-9 version.  OASIS C-1/ICD-10 is “essentially the OASIS C1 with a few technical and typographic corrections and a new name.”

Click here to read more.


CMS To Begin Matching OASIS With Claims

Starting April 1, 2015, Medicare systems will compare the Health Insurance Prospective Payment System (HIPPS) code on a Medicare home health claim to the HIPPS code generated by the corresponding Outcomes and Assessment Information Set (OASIS) assessment before the claim is paid. If the HIPPS code from the OASIS assessment differs, Medicare will use the OASIS-calculated HIPPS code for payment.

The transmission of assessment data and the submission of claims was an entirely separately process previously. The Fiscal Intermediary Shared System (FISS), which processes all original Medicare home health claims, did not have access to the quality data repository. As a result, FISS could not validate the submitted HIPPS code against the associate OASIS assessment.

For several years, CMS planned to create a file exchange interface with the national quality data repository to provide the infrastructure needed to validate HIPPS codes against OASIS assessments. In 2014, MACs successfully began testing the home health OASIS and claim matching process.

Home health agencies are not required to make any changes to their billing systems.

Claims will be suspended temporarily during processing to allow for the file exchange between FISS and QIES. The claims will be suspended with FISS reason code 37071 in status/locations SMFRX0-SMFRX4 and will occur during the 14 day payment floor period. It should not delay payments to agencies.

If no corresponding OASIS assessment is found, the claim will process normally. CMS expects this will change in the near future.

Click here for more information from CMS.

Click here to read more from NAHC.

Tiptastic Tuesday: CMS Issues Urgent Announcement Regarding The HHPPS Grouper

Last week, CMS was notified by jHAVEN and ASAP that certain HIPPS scores being generated within the ASAP were incorrect. The contractor, 3M, analyzed the issue and discovered that certain changes were necessary to ensure proper scoring for XML users. Flat file users do not have to download the corrected grouper. Testing has been completed with a new grouper released on the CMS website. Providers that utilize an XML formal must upload a new grouper. The file is posted on the CMS website. Click here to see it.

Tiptastic Tuesday: When Should Home Health Agencies Begin To Use The OASIS-C1/ICD-9 Data Set?

We have recently received information from the National Association for Home Care & Hospice regarding the use of the OASIS-C1/ICD-9 data set. The M0090 date for all assessments (SOC, ROC, Recertification, Other Follow-Up, Transfer, Death at Home and Discharge) determines which version of OASIS must be completed.

If the M0090, Date Assessment Completed is 12/31/2014 or before, use the OASIS-C data set. If the M0090, Date Assessment Completed is 01/01/2015 or after, use the OASIS-C1/ICD-9 data set.

Note:  If an assessment is completed on or before 12/31/2014, utilizing the OASIS-C data set and the assessing clinician chooses to reassess one or more OASIS items on or after 01/01/2015 during the allowed timeframe for data collection (for example: within 5 days after the SOC, within 2 days of the ROC or DC), this would change the M0090 date and the OASIS-C1/ICD-9 data set must be completed instead of the OASIS-C.

OASIS (HHA) to QIES Assessment Submission and Processing (ASAP) System

Effective January 1, 2015, OASIS assessment data will be submitted to CMS via the national OASIS Assessment Submission and Processing (ASAP) system.

With the implementation of the OASIS ASAP system, home health agencies will no longer submit OASIS assessment data to CMS via their state databases. You will need a QIES/HHA User ID to access the OASIS ASAP system.

If you currently have a QIES / HHA User ID no action is required. This User ID will allow access to both the OASIS (ASAP) Submission System and CASPER Reporting System.

If you do not have a QIES / HHA User ID, refer to the OASIS Access Information page of QTSO at for details regarding how to obtain access.

In order to transition data from the state databases to ASAP, the OASIS submission system will shut down at 6:00 p.m. ET on December 26, 2014. The OASIS ASAP system will be available at 12:00 a.m. ET on January 1, 2015. Files submitted on or after January 1, 2015 must follow version 2.10 (which supports OASIS-C) and version 2.11 (which supports OASIS-C1) of the OASIS data submission specifications.

*If you have any questions or concerns regarding the OASIS ASAP system, please contact the QTSO Help Desk at 800-339-9313 or at