Data Quality Assurance
All home health agencies serving adult, non-maternity Medicare and/or Medicaid patients must submit their OASIS assessment data to their respective state OASIS repository in a standard format. The repository software passes each incoming OASIS assessment record through an extensive set of quality edits. These include internal range and logic checks that assure that assessment items include only allowable values and that they are consistent with each other. When there are significant errors in an assessment, it is not accepted by the repository and the erroneous data are not available to be included in any published quality information. The submitting agency can address the issues and resubmit the assessment with the errors corrected. Only after the data have been corrected will the assessment be accepted by the repository and available for use in calculating published quality data.
In order to avoid problems upon submission to the state repository, most data entry systems in use by agencies incorporate edit checks based on the OASIS data specifications. These identify potential problems for providers before the data are even submitted to the repositories.
View the complete set of OASIS Data Specifications
The repository software also checks submitted assessments against those already received for the same patient to identify gaps in assessment submissions (e.g., a second admission assessment is submitted for the same patient without a discharge having been received). Such errors will generally trigger a warning to the agency, but the assessment will be accepted, assuming it has no fatal errors.
Data accuracy is also supported by the state survey process. Surveyors use OASIS to characterize each agency’s caseload and to select sample patients to be interviewed. They also review and assess the accuracy of the agency’s OASIS assessments.
Finally, for people with Original Medicare, OASIS assessment data serve as the basis for classifying patient episodes into Home Health Resource Groups (HHRGs) for payment. Therefore, the Centers for Medicare & Medicaid Services’ payment contractors will assess the accuracy of a sample of the OASIS assessments as part of their medical review processes.
All home health agencies and all healthcare providers serving Medicare Part A or B patients must submit encounter-level claims data to one of 15 regional Medicare Administrative Contractors (MACs). MACs perform edits on claims before approving or rejecting them. Approved claims are forwarded to CMS’ Common Working File (CWF), which performs its own edits and either accepts claims for payment or returns them to MACs to correct errors. The claims-based quality measures are based on claims in the CWF to ensure data accuracy.