Back to Course

HH02: Structure of Home Health - 3.0 Lecture Hours

0% Complete
0/0 Steps

Participants 1

Module 3, Topic 1
In Progress

HH05: Home Health Claims – Oasis Types Copy

Ian V. Chestnut July 26, 2021

Oasis Types

What is the OASIS assessment?

The Outcome and Assessment Information Set (OASIS) is the patient-specific, standardized assessment used in Medicare home health care, since 1999, to plan care, determine reimbursement, and measure quality of care.

The OASIS collects information on nearly 100 items related to a home care recipient’s demographic information, clinical status, functional status, and service needs.

The OASIS is completed upon admission, discharge, transfer, and change in condition for all Medicare beneficiaries.

The purpose of the OASIS is to be a standardized assessment tool.


OASIS through the years

OASIS             1999
OASIS-B          2002
OASIS-B1        2008
OASIS-C          2010
OASIS-C1       2014
OASIS-C2        2017
OASIS-D          2019
OASIS-D1        2020
OASIS-E           202? coming soon



As identified in (M0080) Discipline of Person Completing Assessment, the comprehensive assessment and OASIS data collection are the responsibility of a registered nurse (RN) or any of the therapies, including physical therapist (PT), speech language pathologist/speech therapist (SLP/ST), or occupational therapist (OT).

A licensed practical nurse or licensed vocational nurse (LPN/LVN), physical therapy assistant (PTA), occupational therapy assistant (OTA), medical social worker (MSW), or Aide may not be responsible for completing OASIS assessments.

In cases involving nursing, the RN is responsible for completing the comprehensive assessment document at the SOC, and may elicit input from the patient, caregivers, and other health care personnel, including the physician, the pharmacist and/or other agency staff to assist in completion of any or all OASIS items.

Any discipline qualified to perform assessments – RN, PT, SLP, OT – may complete subsequent assessments.

For a therapy-only case, the therapist usually conducts the comprehensive assessment. It is acceptable for a PT or SLP to conduct and complete the comprehensive assessment at SOC for a Medicare patient.
An OT may conduct and complete the assessment when the need for occupational therapy establishes program eligibility.

Note: Occupational therapy alone does not establish eligibility for the Medicare home health benefit at the start of care.

The Medicare home health patient who is receiving services from multiple disciplines (for example, skilled nursing, physical therapy, and occupational therapy) during the episode of care, can retain eligibility if, over time, occupational therapy is the only remaining skilled discipline providing care. At that time, an OT can conduct OASIS assessments.


Six Different OASIS Types

  • Start of care
  • Resumption of care following inpatient facility stay
  • Recertification within the last five days of each 60-day recertification period & Other follow-up during the home health episode of care
  • Transfer to an inpatient facility
  • Death at home
  • Discharge from agency


Patient Tracking Sheet:

This information is collected at Start of Care and updated as needed at subsequent time points. Note: Patient Tracking Sheet items are required to be included in the data submission record for each time point, although they are collected at Start of Care and only updated as needed at subsequent time points.


Start of Care (SOC): 

This information is collected at Start of Care in addition to all OASIS items on the Patient Tracking Sheet.


Resumption of Care (ROC): 

This information is collected at Resumption of Care in addition to M0032 Resumption of Care Date on the Patient Tracking Sheet.


Follow-Up (FU): 

This information is collected at Recertification and Other Follow-up.


Transfer (TRN): 

This information is collected at Transfer to Inpatient Facility, with or without Discharge from    Home Health Agency.


Discharge (DC): 

This information is collected at discharge from home health agency other than Death at Home or Transfer to Inpatient Facility.


Death at Home (Death): 

This information is collected when the patient dies while on service with the home health agency, and died somewhere other than an inpatient/outpatient facility or ED.


Start of Care (SOC): 

This information is collected at Start of Care in addition to all OASIS items on the Patient Tracking Sheet.

At the start of care time point, the comprehensive assessment should be completed within five days after the start of care date.


Example of SOC OASIS

  • Click here:
    M0010-M0030, M0040-M0150, M1000-M1033, M1060-M1306, M1311-M2003, M2010, M2020- M2200, GG0100-GG0170


Resumption of Care (ROC): 

This information is collected at Resumption of Care in addition to M0032 Resumption of Care Date on the Patient Tracking Sheet.

At the resumption of care, the comprehensive assessment must be completed within 48 hours of return home after inpatient facility discharge, or within 48 hours of knowledge of a qualifying stay in an inpatient facility. A physician- ordered resumption of care (ROC) must be conducted on or within 2 calendar days of the physician-ordered ROC date.


Example of ROC OASIS

  • Click here: M0032, M0080-M0110, M1000-M1033, M1060- M1306, M1311-M2003, M2010, M2020-M2200, GG0100-GG0170


Follow-Up (FU): 

This information is collected at Recertification and Other Follow-up.


Example of Followup/Recert OASIS

  • Click here: M0080-M0100, M0110, M1021- M1023, M1030, M1200-M1306, M1311-M1400, M1610-M1630, M1810-M1840, M1850-M1860, M2030, M2200, GG0130-GG0170


Transfer (TRN): 

This information is collected at Transfer to Inpatient Facility, with or without Discharge from Home Health Agency.


Discharge (DC): 

This information is collected at discharge from home health agency other than Death at Home or Transfer to Inpatient Facility.

Multidisciplinary cases may have multiple points of discipline-specific discharge, though there is only one HHA discharge, which must include completion of the OASIS discharge comprehensive assessment.


Death at Home (Death): 

This information is collected when the patient dies while on service with the home health agency, and died somewhere other than an inpatient/outpatient facility or ED.

All of these assessments, with the exception of Transfer OASIS and DC OASIS, require the clinician to have an in-person encounter with the patient during a home visit.

The transfer to an inpatient facility requires collection of limited OASIS data (most of which may be obtained through a telephone call).

Not all OASIS items are completed at every assessment time point. Some items are completed only at start of care, some only at discharge.

Remember, for the transfer to inpatient facility, discharge from home care, death at home, and other follow-up, the assessments must be completed on, or within 48 hours of becoming aware of the significant change in condition, transfer, discharge, or death date.



OASIS data are collected as part of the comprehensive assessment required by the Medicare Conditions of Participation. OASIS is not intended to represent a comprehensive assessment in and of itself. HHAs are expected to incorporate OASIS items into their comprehensive assessment documentation and follow their own assessment policies and procedures.


Encoding OASIS Data

Once the comprehensive assessment has been completed and OASIS data collected, HHAs not already utilizing electronic capture of their OASIS data would enter the OASIS information into the computer system, referred to as “encoding.” All the time points of the OASIS assessments have a uniform time frame of thirty days from the date the assessment is completed (M0090 – Date Assessment Completed) for encoding and submitting the data. Once the OASIS data are encoded (in software available from CMS, or other software that conforms to the CMS standard data submission specifications), the agency will review each assessment and edit it for transmission to a centralized data submission system.



Once the OASIS has gone through the Grouper Software it will create a HIPPS code.

HIPPS (Health Insurance Perspective Payment System) codes are equivalent to a specific dollar amount for reimbursement.


Accuracy of Encoded OASIS Data

The encoded OASIS data must accurately reflect the patient’s status at the time of assessment. Before transmission, the HHA must ensure that data items on its own clinical record match the encoded data that are sent to the centralized data submission system.


Transmission of OASIS Data

CMS requires that the HHA electronically transmit the accurate, completed, and encoded OASIS data to a centralized data submission system within 30 days of the completion of the assessment (M0090 Date Assessment Completed).


OASIS Guidance Manual Appendix E Final Validation Report

Once transmitted, the data submission is validated and feedback is provided to the HHA via the OASIS Final Validation Report or OASIS Submitter Final Validation Report as to whether the submission file(s) has been accepted or rejected and whether each submitted record meets the data format and edit requirements.

After the OASIS assessment is complete, locked or export ready, or there is an agency-wide internal policy for establishing that the OASIS data is finalized for transmission to the centralized data submission system,  ​

A physician’s verbal orders for home care have been received and documented,  ​
A plan of care (485) has been established and sent to the physician, and  ​
The first billable visit under that plan has been delivered (optional under PDGM)  ​
An episode will be opened on Common Working File (CWF) with the receipt and processing of the RAP.

A RAP (Request for Anticipated Payment) must be submitted for initial HH PPS episodes, subsequent HH PPS episodes, or in transfer situations to start a new HH PPS episode when another episode is already open at a different agency.
Note: HHAs should submit the RAP as soon as possible after care begins to assure they are established as the primary HHA for the beneficiary.  ​


Centers for Medicare & Medicaid Services (CMS)

For Medicare fee-for-service patients, the transmitted OASIS data also are utilized for billing.

Final claims will not be paid if there is not a corresponding OASIS data set to match that time frame being billed.


Refer to OASIS Validation Reports

Before submitting an HH claim to your MAC, the HHA should ensure the OASIS assessment has completed processing and was successfully accepted into the QIES National Database. The HHA can verify this by reviewing their OASIS Agency Final Validation Report or OASIS Submitter Final Validation Report for the submission which included the assessment. This may require communication between the provider’s billing office and their clinical staff that submits the OASIS to CMS.

HHAs should ensure, prior to submission of the OASIS assessment and the claim, that the following information is correct:

  • HHA CMS Certification Number (OASIS item M0010)
  • Beneficiary Medicare Number (OASIS item M0063)
  • Assessment Completion Date (OASIS item M0090)
  • Reason for Assessment (OASIS Item M0100) equal to 01, 03 or 04

These items will be used to match claims and assessments, so accuracy of submission can help prevent claim denials.


Claims Denied When an OASIS Assessment Has Not Been Submitted

OASIS reporting regulations require the OASIS to be transmitted within 30 days of completion. In most cases, this 30-day period will have elapsed by the time a 60-day episode of HH services is completed and the HHA submits the final claim for that episode to Medicare. Unless you do a different OASIS assessment for your 2nd 30 day period.

Medicare systems will check whether the corresponding OASIS assessment is present in the Quality Information and Evaluation System (QIES). If the OASIS assessment is not found AND/OR the receipt date of the claim is more than 30 days after the assessment completion date reported on the claim, Medicare systems will deny the HH claim.

While the regulation requires the assessment to be submitted within 30 days of completion, the initial implementation of this process will allow 40 days.

Again, for the claim to be denied, the assessment must be both missing AND/OR past due



jHAVEN (Home Assessment Validation and Entry System) v1.4.1, allows Home Healthcare providers to collect and maintain agency, patient and OASIS assessment data for subsequent submission to the appropriate national data repository.

jHAVEN is a free downloadable software application provided by the Centers for Medicare and Medicaid Services (CMS). You can find the jHAVEN Installation and User Guides easily on the CMS website.

Please Note: You not need a previous installation of jHAVEN to download or use jHAVEN v1.4.1. Contact the QTSO Help Desk by phone at (877) 201-4721 or by email to [email protected] for additional instructions or assistance if needed.