Home Health Training: Handle Your NRS Billing Effectively With OASIS


Your claims for nonroutine supplies (NRS) may start bouncing back this month if your OASIS answers and supplies billing don’t agree — and that means less money for you. HIPPS codes continue to be a very relevant piece of that education because it's just very important and you can know a lot about an episode just with HIPPS code because it contains a lot of information.

But there's still developing issues with those HIPPS codes. But many of you or most of you probably are aware that we do have two sets of HIPPS code and that's very unique, very different in the PPS refinement than from the original PPS.

So any of those HIPPS codes that end in an alphabetic character, that is what would be billed on all of your RAPs but you would only bill it with that alphabetical character. In the position on your final claim if non-routine supplies were actually provided to the patient. If non-routine supplies were not provided to the patients during the episode, then the final claim should be billed with a HIPPS code that ends with a number instead of the alphabetic character.

AS per the new healthcare guidelines, every HIPPS code corresponds to one of 918 unique episode payments. And that is actually for every CBSA in rural area. So under the original PPS, we had 80 payment categories. We now have 918. So it is certainly a drastic change under this (consist them) and one is hopefully many of you are we getting to get accustomed to probably not seeing too many HIPPS codes or payments that are the same as other episodes, probably seen a wide variety of those.

But the HIPPS code essentially, what they represent are three different episode elements. And those each of those elements is generated from directly from the OASIS assessment and that includes the payment grouping, the HHRG score and the non-routine supply severity level.

Home Health Training Example: HIPPS code of 3BFKS. So in that first position, what we're seeing is the payment grouping. And so we know payment groupings can be any number of one through five and they each mean something very unique, very specific. Those military characters are representing the clinical functional and service utilization scores or rather HHRD scores which again come directly from the OASIS assessment.

And then that last position in this example is an alphabetical character but it could also be a number and that is the fifth position, that is the non-routine supply severity level.

With the OASIS matching string, we mention that is very significant to episode payment and that’s very new because under original PPS, we have the equivalent of the OASIS matching string which we simply call the OASIS matching key. And that piece of information is just represented OASIS data, had no implications on payment and was essentially just something that we had to report.

Well, at this point under the home health rules, under PPS refinement, the string of characters is actually determining in some cases your episode payment so it's very important that we have a good comprehension of that string and how it relates back to our HIPPS code and payment.

So the OASIS matching string, is it essentially representing six elements of OASIS data as well as episode payment data. So it's telling us the started care date, the assessment date, the reason for assessment as well as the episode timing all of which would have been documented on the actual OASIS assessment.

And then lastly it is also telling us the number of clinical and functional dimension severity point. Now, in order to really describe what that is meaning, we have to go back to PPS refinement being based on a four equation case mix model.

Now, those four equations, when you also factor in the therapy thresholds, the three therapy thresholds, what we are left with are five different payment grouping. So even though we have five payment group, and these are a little confusing because they were actually only four case mix equations. And those case mix equations are ultimately what is determining the episode payment.

So within each of those equations there is a score that is provided for the clinical dimension, the functional dimension and the service utilization dimension. So within the CMS OASIS string, basically what it is telling us is that for each of those four equations, the clinical dimension severity points which essentially could also be referred to as your clinical score.

And the reason that those would be different under each of those case mix equation is that the whole basis of those case mix equations is that for the same assessment, you would have a different score if that patient fill into the equation one versus equation four and that all depends on the therapy and the episode timing as to which equation applies.

Get more home healthcare training on topics like these at AudioEducator.