OASIS is a popular documentation process in home health, and its demand has been growing significantly. It helps the providers to track and measure the patient’s health outcomes. But currently, the clinics are finding the OASIS process to be a highly complicated affair. The reason is that the healthcare staff juggles amongst the administrative tasks and patient care, leaving no time for this process. That's where the outsourced home health billing experts portray a crucial role who take care of the OASIS process.
Defining OASIS in Home Health
OASIS is abbreviated as “Outcome and Assessment Information Set” which is a data collection tool used in home health to measure the patient’s health status. It is described as the backbone of quality measurement to make clinics do a proper documentation process which can streamline their claim submission process. This process includes functional and clinical status, patient demographics, service needs, and other treatment details.
It applies to all Medicare-certified home health clinics as part of the data collection episode of CMS. This episode incorporates care start and resumption, transfer, follow-up, and finally, discharge. These data points provide important insights for accurate Medicare reimbursement process. Here, the outsourced home health billing services know all the complex nuances of the claim submission process to make sure no issue occurs.
Major Components of the Home Health Assessment Compliance
The OASIS components incorporate patients’ clinical condition, demographic data, comorbidities, and living situations. You need to know that all the necessary items are high-risk condition indicator. Let's delve into the key components in detail to understand how they work:
Essentials of the OASIS Documentation
Accurate documentation includes constant CMS coding convention usage as well as auditing protocols to catch issues before the claim submission procedure. That is why payment errors and regular audit survey citations are highly important processes. As the healthcare staff stay busy with all this, that’s why the home health clinics come to the rescue who know all the complex nuances of the OASIS documentation procedure.
Home Health OASIS Forms
CMS has published all the OASIS assessment user manuals. These agencies need to maintain all the latest datasets and can integrate into the EHR workflow so that the clinics can complete all the items in the correct assessment windows. Always remember that the electronic submissions and all-payer reporting timelines create the OASIS process.
Common OASIS Q&A
The frequently asked questions in OASIS include who needs to complete each OASIS item, what’s the ROC window is about, and how to handle the caregiver-reported items. All the agencies need to know about the CMS OASIS Q&A for all the definite interpretations. Hence, these questions help to create a proper documentation process.
Integrated OASIS in the Medical Billing Process
OASIS misclassification or assessment leads to increased audit risks or underpayments. Clinics need to view the OASIS process as an important clinical instrument, which is why the outsourced home health agencies have become important.
Why Choose Outsourced Home Health Billing Experts?
The agencies need to use OASIS datasets for retrospective validation, forecasting impact of claims and risk-adjustment analytics beyond immediate payment. So, regular reconciliation amongst submitted claims and OASIS-derives groupings uncover all the coding gaps and training needs. Hence, high-quality OASIS assessments need cleaner claims, better financial performance and stronger compliance. However, keeping OASIS workflows updated with the CMS guidance, integrating into the billing system, and auditing OASIS-to-claim alignments are important steps the home health clinics need to prioritize to improve quality reporting and deliver better care.
There are several steps which the outsourced companies perform such as:
- Documenting basic patient demographic details
- Verifying the patient’s insurance eligibility
- Documentation and charge entry for all the provided services
- Completing the prior authorization process
- Coding, creating and submitting the claim
- Following up on the claim submission
- Receiving payer reimbursement
- Posting payment details in the EHR process
These companies help with verifying the patient’s insurance eligibility, proper coding, prior authorization, claim tracking, denial management, accounts receivable management and financial reporting. However, these services provide relevant expertise and customized solutions to make sure no issue occurs. They also help with technology-driven efficiency and provide dedicated support to make sure no issue occurs. These third-party experts can reduce your operational costs by 80% and work with 10% buffer resources to make sure no employee shrinkage occurs. These companies also work with 99.9% accuracy and have 100’s references to make sure no problem occurs.
The outsourced experts stay updated with all the latest CPT, ICD, and HCPCS codes to make sure no claim denial occurs. They also streamline the prior authorization process by verifying the patient’s insurance eligibility, collecting important documents, and then submitting PA requests to make sure no claim denial occurs. The in-house staff consume a high cost because you need to train them and also buy expensive office space for them. On the contrary, the outsourced experts are previously trained and don’t need any separate office space which can lead to claim denial. Furthermore, these experts know how to work with the clinic’s EHR system to protect patient data and know how to use the electronic prior authorization procedure to submit claims electronically. So, if you want to streamline your billing process, it can be a feasible decision to outsource home health billing companies in that matter.
