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Test Your Knowledge Answers: 

1) To answer your question, the Conditions of Participation (CoP) state completion of a comprehensive patient assessment is required, even when the patient is known to only need a single visit in the quality episode. Based on CMS policy, OASIS data collection, and submission are not required when only one visit is made in a quality episode (SOC/ROC date to TRN/DC). However, to bill Medicare PPS (PDGM) for a single visit payment period, OASIS data must be collected and submitted to the OASIS system and used to calculate a HIPPS code for inclusion on the Medicare claim. If you choose not to bill Medicare for the single visit provided, there is no requirement to collect and transmit OASIS data for single-visit quality episodes. The documentation should note that no further visits occurred. No subsequent discharge comprehensive assessment including OASIS should be collected or submitted. (Information gathered from the OASIS-E, instant OASIS Answers, page 540) 

2) OASIS reporting regulations apply to all Home Health Agencies (HHAs) required to meet the Medicare Conditions of Participation and are applied to all skilled Medicare and Medicaid patients of that HHA, with some exceptions. Skilled Medicare and/or Medicaid patients who are excluded from the OASIS requirements include: 

• Patients under the age of 18 

• Patients receiving pre- & post-partum maternity services 

• Patients receiving personal care only 

Per regulatory requirements, patients requiring OASIS will be identified on M0150 – Current Payment Source by one or more of the following responses: 

• 1 – Medicare (traditional fee for service) 

• 2 – Medicare (HMO/managed care/Advantage plan) 

• 3 – Medicaid (traditional fee for service) 

• 4 – Medicaid (HMO/managed care). For technical questions, OASIS data submission/transmission, , Submission Error messages or record rejections, or OASIS data submission specifications contact the iQIES Help Desk, E-mail: iqies@cms.hhs.gov , Phone: 1-800-339-9313.

All HHA users are expected to submit required OASIS records to CMS via the internet Quality Improvement and Evaluation System (iQIES).

The reporting requirement is located within the Reporting OASIS Information Condition of Participation at 42 CFR 484.45. 

484.45 Condition of participation: Reporting OASIS information. 

HHAs must electronically report all OASIS data collected in accordance with § 484.55. 

Standard: Encoding and transmitting OASIS data. An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted. (Response provided by The CMS Home Health Quality Help Desk Team) 

3) "Encode" refers to entering OASIS information into a computer and "Transmit" refers to electronically sending OASIS information, from the agency directly to CMS via the national iQIES system.

4) True

5) Special Healthcare service or program that help a person regain physical, mental, and/or cognitive (thinking and learning) abilities that have been lost or impaired as a result of disease, injury, or treatment. Can include, for example, physical therapy, occupational therapy, speech therapy, and cardiac and pulmonary therapies.

6) A surgical wound with staples in place would only be considered not healing if it meets the definition of not healing as outlined in the OASIS Guidance Manual. 

Definition of not healing as outlined in the OASIS Guidance Manual:

• The wound bed has > 25% avascular tissue - AND/OR

• Signs/symptoms of infection - AND/OR

• The wound bed is clean bit non-granulating - AND/OR

• Wound edges are closed/hyperkeratotic - AND/OR

• Persistent failure to improve despite appropriate comprehensive wound management.