Final claims sent where the OASIS assessments have not been received and accepted by CMS prior to billing will be denied. You may not be able to rebill and collect payment. A sent date does not indicate that the assessment was accepted by CMS. Acceptance information comes from the OASIS Validation Report. Agencies have starting reporting these types of denials and some were not aware, even though we have posted on Allegheny Messages.
Main Office Software version 6152 dated 05/30/2017 contains a new checkbox under Insurances/Insurance Company tab and the PPS tab that when checked will require a CMS Assessment ID (which comes from the validation report) or marking that the assessment was received, before a final claim can be created. This CMS Assessment ID or indicating the OASIS was received by CMS can be entered in Create OASIS XML screen using the “Accepted” button or in the view screen for the assessment under patients, or in the Edit PPS Billing Info screen.
Agencies using the “Accepted” button in the Create OASIS xml screen can now filter the screen by the software CMS Sent date to pull a list of all the assessments contained in the received Validation report to efficiently post the CMS Assessment ID or mark the assessment as accepted.
The entry fields have been in the software since early this year.