M0150: CMS OASIS Q&As

The purpose of this data item is to identify the current payer(s) that your agency will bill for services provided by your agency during this home care episode. Note that the text of M0150 Current Payment Sources for Home Care asks for the "current payment sources" (emphasis added) and contains the instruction, "Check all that Apply." The clinician should indicate at admission all pay sources that the agency will bill for services by checking all of the appropriate responses. The item is NOT restricted to the primary payer source. When a Medicare patient has a private insurance pay source as the primary payer, Medicare may be considered a secondary payer. For example, when a Medicare patient is involved in a car accident and someone's car insurance is paying for their home care, Medicare is the secondary payer and the response to M0150 should include either Response 1 or 2 as appropriate for that patient. Although the agency may "intend" that the private pay source will pay the entire cost of the patient's home care that usually cannot be verified at start of care and may not be determined until the care is completed.

The purpose of M0150 - Current Payment Sources for Home Care is to identify any and all payers to which any services provided during this home care episode are being billed. Although the patient described is a Medicare beneficiary, Response 1 of M0150, Medicare (traditional fee-for-service), would not be marked, since the current situation described does not meet the home health benefit coverage criteria. If at some point during the care, a change in patient condition results in the patient becoming homebound, and otherwise meeting the home health benefit coverage criteria, then a new SOC assessment would be required, on which Response 1 - Medicare (traditional fee-for-service) would be indicated as a payer for the care.

Different States, different payers, and different agencies have varying responses to these payer change situations, so we usually find it most effective to ask, "Does the new payer require a new SOC?" HHAs usually are able to work their way through what they need to do if they answer that question. If the new payer source requires a new SOC (Medicare is one that DOES require a new SOC), then it is recommended that the patient be discharged from the previous pay source and re-assessed under the new pay source, i.e., a new SOC comprehensive assessment. The agency does not have to re-admit the patient in the sense that it would normally admit a new patient (and all the paperwork that entails a new admission). When transitioning from a skilled Medicare or Medicaid patient to a situation not requiring OASIS (e.g., moving from skilled Medicare to personal care only), CMS encourages HHAs to complete a discharge assessment at the last visit under the Medicare or Medicaid pay source. While this is not a requirement, conducting a discharge assessment at the point where the patient’s skilled need has ended provides a clear endpoint to the patient’s episode of care for purposes of the agency’s quality initiatives.

If the patient has both VA and Medicare and both are expected payers, then you need to mark Response 1 - Medicare (traditional fee-for-service) and Response 7 - Other government (e.g., TriCare, VA). But if the patient does not have Medicare, or Medicare is not an expected payer for provided services, then Response 7 - Other government (e.g., TriCare, VA) would be the correct response.

Identified errors must be corrected whenever errors are discovered, recognizing that there may be payment or quality measure implications. Effective January 1, 2020 home health agencies have up to 24 months from the assessment’s M0090 - Date Assessment Completed to correct an OASIS record.

M0150 - Current Payment Sources for Home Care, is asking for identification and reporting of any payers the agency plans to bill for services during this episode of care. When a Medicare patient is admitted for home care services under a private insurer and the Medicare is considered to be a secondary payer then Medicare would be included in M0150. This action will ensure that OASIS data is collected in the event Medicare is a payer. If at the end of the episode, the agency did not bill Medicare for services, (and assuming there were no other Medicare or Medicaid payers for home health services), then the agency should take action to correct M0150 in any and all assessments (e.g., SOC, Transfer, ROC, Discharge)When the assessment reports Medicare as a payer in M0150 for an episode where Medicare is not billed, if M0150 is not corrected, the patient data may inappropriately impact quality initiatives.

Response 8 - Private Insurance refers to private health insurance. Response 11 - Other (specify) would be selected for home care services expected to be covered by auto insurance.