OASIS-C1 Reimbursement Comparison (Complementary Tool)

By Barbara Rosenblum
December 08, 2014 Home Health

We’re in the final stretch of preparing all the SHP home health reports, alerts and edits to fully support the new OASIS-C1 data set that goes into effect January 1st, 2015. Home health agencies may find the number of changes CMS made to the OASIS variables and thresholds that now constitute the different scoring levels of Clinical and Functional overwhelming. The number of OASIS parameters that are used in scoring HHRGs has dropped from 51 to 40.

Demo of Alert Details Results

We also note that while overall points have decreased, they are offset by lower HHRG point brackets. This means that fewer points are required for HHRG scoring, especially in the clinical domains. In fact for late episodes with 0 – 13 therapy visits, just one point is the difference between a C1 to C2 or C2 to C3. Every point counts!

We prepared a document of the OASIS-C to C1 changes to help you visualize how the HHRG scoring was affected, including the mapping and scoring of the new clinical, functional and service domains. Please use the link below to request a copy of the SHP PPS & NRS Point Scoring 2014/2015 Comparison Guide.

SHP PPS & NRS Point Scoring Comparison Guide

Along with checking that your EHR vendor is prepared to use the new OASIS C-1 scoring for episodes ending January 1st and forward, we are recommending to our clients that they tighten up their review and accuracy of all OASIS assessments and related documentation to limit unnecessary payment loss. Although CMS has noted that the net reimbursement changes will most likely offset each other and be a ‘wash’ across the industry, some agencies will benefit and some will suffer based on patient mix and documentation practices.

Demo of Alert Manager Results

In some cases, we have seen HHRG case weights increase and decrease as much as 13% between OASIS C and C1 scoring. SHP clients should pay particular attention to the SHP Alert Manager & OASIS-C1 edits. With every change that CMS makes, it is important home health agencies double up their efforts to ensure the OASIS coding processes are continually evaluated for accuracy and efficiency.

A couple of noted differences in the calculations include:
  • Points no longer available for DX groups include:
    • Blindness/Low Vision
    • Psych 1, Psych 2
    • Pulmonary Disorders
  • Points no longer available for the following M-items:
    • M1200 – Vision
    • M2030 – Injectable Drug Use
  • NRS scoring is not changing between C and C1