Article Content

There are anecdotal reports that some nurses and therapists are being trained to "upcode" OASIS-to record the OASIS form in such a way to increase payment under the Prospective Payment System. There also are vendors selling computerized systems to inaccurately maximize OASIS coding to increase revenues.


OASIS, as most home healthcare providers know, is a supporting form for Medicare and Medicaid billing. As such, purposely incorrect and inflated coding can be considered a fraudulent action. This puts the nurse or therapist at risk for two serious complications: state and federal fraud charges and the possibility of nursing and therapy licensure action by the state-based practice authorities.


Claims by nurses or therapists that they are simply doing what they've been told to do will not hold water in an investigation. In the same way that nurses, for example, have a standard of care to challenge excessive orders for narcotics, nurses and therapists who are directed to artificially score OASIS are violating their professional standards of care regarding legal documentation processes.


Similarly, a claim of ignorance for correct coding guidelines is not supportable because of the freely available OASIS training from CMS and other sources, including back issues of Home Healthcare Nurse. Although questions and confusion regarding OASIS continue, there are resources at the state and federal level for direct, in-person support, including state-based OASIS education coordinators in all 50 states. See


So where does this leave nurses and therapists who work in agencies that encourage or demand "upcoding?" From my view, the choice is clear. Which is most important: That particular job or your license and your reputation? As Ralph Waldo Emerson said, "A little integrity is better than any career."

FIGURE. No caption a... - Click to enlarge in new windowFIGURE. No caption available.