Home Health · PDGM & OASIS

The chart has to match the payment.

Medicare home health is paid and measured from the same record. Cardinal BPS reviews OASIS, coding, and the claim so the clinical picture, the PDGM group, and the cash describe one patient.

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Payment starts in the assessment

Under PDGM, each 30-day period is grouped from clinical grouping, functional impairment, comorbidity, admission source, and timing. Those inputs come from OASIS and the diagnoses on the claim.

Quality uses the same chart

OASIS also feeds quality reporting, value-based purchasing, and survey review. An item that is wrong for payment is usually wrong for the quality record too.

The mismatch is the risk

Denials and underpayment show up when the visit note, the OASIS, and the diagnosis do not describe the same patient. That is the work we review.

What we look at

The items that actually move a 30-day period.

Start of care, resumption, recertification, and discharge OASIS
Diagnosis sequencing and the comorbidities that change the group
Functional items that move the impairment level
Nursing, therapy, and physician narrative against the OASIS
The claim, before it is submitted
The remittance, when the period pays or adjusts

Where this lives in the work

Coding, OASIS, therapy, and the claim are one review.

OASIS review

Item-level review of the assessment against the clinical record, with the gaps called out before they become a payment or survey problem.

OASIS Review

Coding

Diagnosis sequencing and comorbidity capture that support the clinical group the documentation can actually defend.

Medical Coding

The claim

Clean submission, denial prevention, and follow-up so an accurate OASIS is not lost after it leaves the agency.

Revenue Cycle Management

Therapy

PT, OT, and ST evaluations and re-evaluations reviewed so the functional picture matches the care in the chart.

Quality Assurance