CMS recently issued Transmittal SE1504 entitled “Payment Codes on Home Health Claims Will Be Matched Against Patient Assessments”.

In this Transmittal, CMS advises that, beginning on 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.  As of now, if no corresponding OASIS assessment is found, the claim will still process normally.

Submission of an OASIS assessment for all home health episodes of care is a condition of payment according to CMS. CMS advises that if the OASIS is not found during medical review of a claim, the claim is denied. Claims that don’t match may be automatically selected for Medical Review. Additionally, it is important to note that eventually CMS will use this new claims matching process to deny claims and enforce the condition of payment.

A copy of the transmittal can be found here –>  http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2495CP.pdf