MsJaneRules-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
Flags route automatically to the right reviewer category. 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 →
every score change, timestamped and attributed →
The 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.
Six compliance checks, live today
Not a roadmap slide — these run on every assessment right now, each one tied to the specific CMS or CFR reference behind it.
NOA timing
Flags admissions approaching the 5-day Notice of Admission filing deadline while there's still time to file.
LUPA risk
Flags episodes on pace to fall under the visit-count threshold for their HHRG, before the period closes.
Classification accuracy
Recalculates admission source and episode timing from claims history and flags any mismatch against what was submitted.
Comorbidity adjustment
Maps secondary diagnoses to CMS's published comorbidity subgroups and calculates the Low/High adjustment tier before submission, not after.
Face-to-Face compliance
Checks the physician certification requirements under 42 CFR 424.22(a)(1)(v) are on file and timely, one of the most common reasons claims get denied.
RCD readiness
For agencies in Review Choice Demonstration states, tracks your own approval-rate trend against CMS's 90% threshold before CMS's own report does.
Every score, traceable, forever
Every assessment carries a full history: every readiness score, every routing decision, every sign-off, timestamped and attributed. If a score changes between visits or clinicians without a documented reason, that's visible in the record, not buried in a database somewhere. This is what makes a flag defensible in an audit instead of just a claim you're asking someone to trust.
What happens after a denial
QA catches problems before submission. The rev cycle module picks up what still gets denied: appeal drafts are already built and templated from the documented facts in the original assessment — citing the specific CMS rule, not AI-generated guesswork. Automatic denial ingestion from remittance data is rolling out next.
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