Purple Hearts Home Health

“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 371 of 598 (68.96%) records submitted. The agency did not code and electronically submit 371 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. Findings included: Record review of an iQIES Error Summary Report dated 03/03/24 to 03/03/25 indicated the agency failed to code and electronically transmit 371 OASIS assessments data to the CMS system within thirty days of completing the assessment of the beneficiary. During an interview on 3/6/25 at 9:31 a.m., Staff D said she was the billing manager, and that she responsible for submitting OASIS assessment data after it was completed by the agency staff. Staff D said the OASIS data was required to be submitted within 30 days after the assessment was complete. Staff D said the agency had identified a problem in that the person responsible for assigning codes to the assessment data had mad many errors. Staff D said the Alternate Administrator/Supervising Nurse was the person responsible for reviewing the assessment data before it was submitted and she had not been able to review the data due to illness. Staff D said she received a report when submitting the OASIS data which indicated the assessment data was late but was not aware of the number of assessments that had been submitted past the 30-day deadline. During an interview on 3/6/25 at 11:00 a.m., the Alternate Administrator/Supervising Nurse said the agency identified the root cause of late OASIS submissions as: 1) agency nurses not submitting the OASIS assessment data in a timely manner; 2) no one was reviewing the assessment data while she was in the hospital; and 3) miscommunication among all staff involved in the QA process as to who was responsible for which task in the process of reviewing and submitting OASIS assessment data. The Alternate Administrator/Supervising Nurse said when she returned to work there were over 350 assessments and notes waiting to be reviewed. She said at that time there was no one but her who could review the assessment data. During an interview on 3/6/25 at 11:30 a.m., the Administrator/Alternate Supervising Nurse said she was aware that there was an issue with the OASIS assessments being submitted within the 30 day window. She said there were several factors including the Alternate Administrator/Supervising Nurse’s hospitalization and resulting inability to review the assessments, agency nurses being lax in getting the assessments completed and turned in, and inaccurate coding (assigning codes to specific data points). The Administrator/Alternate Supervising Nurse said at the time the agency was not utilizing the iQies Error Report but had begun running the report at least weekly. Record review of an agency policy titled Outcome and Assessment Information Set (OASIS), reviewed 09/01/24, indicated: · OASIS assessments should be reviewed to ensure that the data is complete and timely. If it is incorrect, clinician will be contacted to correct it as soon as possible due to the time constraints on OASIS submission. It is critical that assessments be submitted timely. · An agency may be fined for untimely submission of the OASIS · Not receive reimbursement for the patient/client care that has been provided. · Be terminated from the Medicare program. · The Agency is required to submit all OASIS assessments to the national database specified by CMS within 30 days of the M0090 date.”