CMS shifts from denials to RTPs for home health claims with no matching OASIS

The following story is from Home Health Line.

Home health agencies will now have their claims returned when Medicare systems fail to match those claims with a corresponding OASIS assessment.

Based on new requirements that went into effect in April, agencies started receiving denials when a claim was submitted, but a matching OASIS could not be found.

On Oct. 12 CMS announced this situation will no longer result in an automatic denial, but instead CMS will Return to Provider (RTP) home health claims that fall into this category.

Agencies can use the F9 function to resubmit the claim, but should take action before doing so.

CMS says agencies should do one of the following before resubmitting claims:

  • Update the Health Insurance Claim (HIC) number on the OASIS assessment to match the current information
  • Correct the assessment completion date reported in the claim treatment authorization code to match the OASIS assessment
  • Resubmit for denial using condition code 21 and Type of Bill 320 if the assessment was not submitted

View the update from CMS:

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