Caringville Home Health Services

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on interview and record review, the agency failed to code and electronically transmit each completed OASIS (data collected as part of the comprehensive assessment) assessment to the CMS system within thirty days of completing the assessment of the beneficiary for 1 of 2 assessments submitted (50%). The agency did not code and electronically submit 1 patient’s OASIS data to IQIES (electronic system used to transmit quality measures from the OASIS data collected during comprehensive assessments) within 30 days to track and evaluate changes in the patient’s health while admitted to home health services to help ensure quality healthcare for patients. This failure prevented the agency’s patient OASIS data from being made available to CMS for analysis of patient care performance and could cause negative patient outcomes. Findings included: Record review of an IQIES Error Summary Report dated 05/12/25 to 05/12/26 generated by the surveyor during pre-survey on 05/12/26 indicated the agency failed to code and electronically transmit 1 of 2 OASIS assessments data to the CMS system within thirty days of completing the assessment of the beneficiary. During an interview on 05/12/26 at 10:40 a.m., the RN Administrator said the agency serviced 1 patient in the last 12 months, which was in December of 2025. She said the patient was on service for a couple of weeks. The RN Administrator said she did OASIS and submitted them to CMS in IQIES. She said there was an issue with getting the face to face [requirement by Medicare (health insurance program) of a face-to-face encounter between a patient and a physician (or authorized practitioner) to certify eligibility for home health services] back from the doctor, and that slowed things down for submission. She said this was her first OASIS to submit to IQIES/CMS. She said she did not know the timeframe, and she thought she submitted it timely. During an interview on 05/12/26 at 10:55 a.m., the RN Administrator said she submitted OASIS twice in IQIES. She said once was for admission and once for discharge. She said Patient #1 was the agency’s first and only patient and she was trying to learn how to do OASIS transmissions because it was her first time. She said the OASIS might have been a few days late because the agency didn’t get the face to face back on time from the doctor and that delayed everything. She said Patient #1 was on service for about 30 days and the agency had to fill in the face-to-face visit date on the OASIS to submit, and the agency didn’t have the face-to-face back. She said the agency kept notifying the doctor’s office that they needed the face to face and the agency couldn’t just put dates in on the OASIS. She said she thought the start of care OASIS was a few days late. During an interview on 05/13/26 at 10:58 a.m., the RN Administrator said the importance of submitting OASIS timely was for CMS to be aware of patients being admitted and gave CMS information about the patient. She said it was also important for the agency for billing. She said if CMS had to do a review, OASIS needed to be transmitted timely so CMS could do reviews on time. Record review of an Outcome and Assessment Information Set (OASIS) policy dated 01/01/26 indicated “…The Agency is required to submit all OASIS assessments to the national database specified by CMS within 30 days of the M0090 date…” Record review of a Timelines policy dated 01/01/26 indicated “…All completed and encoded OASIS data will be transmitted via electronic communication software that is available from CMS or software that conforms to CMS electronic record layout, edit specifications and data dictionary, and that includes the required OASIS data set and the CMS assigned branch identification number, as applicable. It will be transmitted using electronic communications software that complies with the Federal Information Processing Standard… from the agency or the Agency contractor to the CMS collection site within 30 days of the M0090 (date of completion) date…””