What does OASIS Stand For?
If you are in home health, then you are inseparably connected to OASIS. Many ask, what is OASIS? Simply put, OASIS is Outcome and Assessment Information Set. This means that OASIS is a tool that CMS uses to collect certain information from home health providers licensed with Medicare with each episode that home health agencies (HHA's) have with a Medicare patient. An episode is a 60-day period that begins with a referral from a physician, which then schedules a visit with a patient. The initial visit at the beginning of an episode is called the Start of Care (SOC). It is at this point that a clinician (nurse, physical therapist, speech therapist, occupational therapist) completes the OASIS assessment. The purpose of OASIS is to gather information, and paint, if you will, a picture of the patient given the patient medical history (PMH), face to face (F2F), assessment by qualified clinicians and associated discipline evaluations from other qualified clinicians, (Speech therapy, skilled nursing if a therapy case, physical therapy, or occupational therapy). These qualified clinicians will document their findings based on the patient's ability to perform, AND the condition of the patient's capacity to perform on various questions. The clinician will then "score" the responses based on observation, questions, and documentation.
What is OASIS data?
Once the OASIS has been performed and collaborated, agencies will then either take the information and send the record to an outsourcing agency to add diagnosis coding and review the OASIS for accuracy and compliance or have an internal person add the diagnosis codes and review the OASIS. This information is then sent to CMS, actually the intermediary, for review and then the agency bills at the end of the 60 day episode. The information on OASIS is broken down into several sections. There are social/ethnic questions, mental and cognitive health/ability questions, head to toe assessment to see what the patient is able to do safely inside the home. The data that CMS wants agencies to send changes from time to time. That creates revisions of OASIS which then creates new versions of OASIS. Sometimes CMS doesn't want any more information on a certain area. That is not often the case. More often, CMS will take one question and turn it into clarifying or multiple questions. CMS tracks much of this data to learn about patients and agencies. CMS uses the data to create and refine policy, but also to determine payment to agencies based on the data provided by agencies. Before a patient ends service, there is a discharge OASIS. The clinician (or sometimes last qualified visit) will compare the SOC OASIS at the beginning of the episode to what the patient can do at the end of the episode. The difference between the SOC and discharge is called an outcome. What changed with the patient? Did the patient improve? Did the patient decline? In what areas? How? Agencies are effectively graded on the outcomes of the patients on discharge through programs such as 5 Star Ratings (showing the quality of improvement on outcomes) and Home Health Value Based Purchasing- providing quality care at home which keeps the patient out of the hospital- more expensive for CMS.
Why is Oasis Important in Home Healthcare?
The answer simple. What information agencies send back via OASIS data is used to create policy and reimbursement. Often, agencies don't send the correct and accurate data back to CMS- which leads to policy based on inaccurate, incomplete, or noncompliant data sent to CMS. Further, agencies usually aren't getting credit for the good work they're doing. Most of the time, patients did improve in outcomes. They just don't get credit for it. Most of the time, the clinician at SOC (or recert, or ROC) didn't understand certain OASIS questions and what the question IS and IS NOT asking. If the clinician answers incorrectly at the SOC, then the likelihood of the clinician answering correctly on discharge is not high OR there is no room for improvement and the patient isn't recorded as having improved but actually did improve significantly.
How Can Home Care Answers help?
Home Care Answers exists to help agencies ensure that OASIS and coding is correct, accurate, and compliant. Compliance, reimbursement, and outcomes are natural consequences of accuracy. We have several resources to help agencies. We offer quality coding and OASIS review to ensure your agency maximizes accuracy, compliance, reimbursement, and outcomes. We have a few blog articles on OASIS. Here are a few:
Here are some great links for OASIS E PDF, OASIS E Guidance Manual
To find out how we can help, we offer a free trial to quantify what your agency could be missing.