Rules-based OASIS-E2 QA
OASIS review that shows its work.
MsJaneHH checks home-health OASIS-E2 assessments against deterministic CMS rules — and shows the exact guidance reference behind every flag. Instant, transparent, and private to your agency. No AI guessing, no data pooling.
Bedfast (M1860 = 05) is inconsistent with independent bathing (M1830 = 00).
OASIS-E2 Guidance Manual · Ch. 3 §G Functional StatusPrimary diagnosis is required and cannot be a V, W, X, Y, or E code.
OASIS-E2 Guidance Manual · Ch. 3 §I Active DiagnosesPresent and consistent with the start-of-care date.
From assessment to submission-ready
Four steps. Every flag is traceable; nothing is auto-answered for the clinician.
Guided assessment
The clinician answers OASIS-E2 items one at a time, with skip logic so only relevant items appear.
Validation with citations
Deterministic CMS edit checks run instantly and flag issues — each with the specific guidance reference behind it.
Correction & QA sign-off
A reviewer assigns each flag back to the clinician. Once corrected, MsJaneHH re-checks the fix itself before the reviewer gives final sign-off — closure isn't just taken on someone's word.
Export, gated on real errors
Once every flagged error is resolved, export the CMS-shaped file. If hard errors are still open, export stays blocked — automatically, not by policy.
Guidance Manual, effective 2026-04-01 · Data Specs V3.02.0
generated from CMS's own data dictionary →
ruleset oasis-e2-v2026.04.01
The four things that actually get claims denied
Industry denial-trigger reporting for 2025–2026 names four recurring causes: late or missing Notices of Admission, face-to-face certification errors, insufficient medical necessity evidence, and OASIS/PDGM mismatches. That's not a loose theme — it's close to a checklist, and it's what MsJaneHH is built to catch.
$600+ per episode
The financial gap between adjacent PDGM payment groups when a functional or clinical grouping score is off by one level. Across a 100-patient census, that's a five- or six-figure swing in a year.
7.7% improper payment rate
CMS's own Comprehensive Error Rate Testing program found this rate on home health claims nationally — roughly $1.2 billion in payment inaccuracies in a single year.
1 in 13 episodes hits LUPA
The national average LUPA rate runs 7.6–9.79% depending on the data cut — a full case-rate payment quietly becoming a much smaller per-visit one.
Sources: CMS Comprehensive Error Rate Testing (CERT) program data; McBee Associates analysis of CMS claims data; industry PDGM billing and denial-trigger reporting, 2025–2026. Figures are industry averages, not a guarantee for any specific agency.
See what affects payment before you submit
Some OASIS items feed directly into PDGM case-mix scoring. MsJaneHH flags the ones worth a second look — not to maximize payment, but so the record is complete, consistent, and supportable before it goes out the door.
NOA timing
Flags admissions approaching the 5-day Notice of Admission filing deadline while there's still time to file, not after the payment is already lost.
LUPA risk
Flags episodes on pace to fall under the visit-count threshold for their HHRG while there's still time to adjust the visit plan.
Classification accuracy
Recalculates admission source and episode timing from claims history and flags any mismatch against what was submitted — before it affects your case-mix weight.
Now building: risk adjustment that protects payment and quality scores
A single missed comorbidity or off-by-one functional score doesn't just cost money today — it sets the baseline CMS uses to risk-adjust your public quality measures and Star Rating tomorrow. Under-documented complexity means lower reimbursement and a quality score that looks worse than your actual care. The risk adjustment suite — in development — flags both sides of that gap before submission.
See how it worksNow building: what happens after a denial
QA catches problems before submission. The rev cycle module — in development — picks up what still gets denied: matching denial codes to CMS rules, drafting appeals from documented fact, and tracking every deadline.
See how it worksPricing you can read before you call
Unlike enterprise EHR platforms with custom quotes, our tiers are public — from a low-cost pilot to multi-agency consultant plans.
See pricingBring transparent OASIS QA to your agency
We're onboarding pilot agencies and consultants now.
Request pilot access