OSCAR System

4149 - OSCAR System (Rev. 1, 05-21-04) 4149A - Summary (Rev. 1, 05-21-04) The Online Survey Certification and Reporting System (OSCAR) collects provider and supplier certification information and generates reports which compile this information into a workable format. The SA has primary responsibility for entering all recertification and Medicaid initial survey data, except for nursing homes and home health agencies, into the Online Data Input and Edit (ODIE) subsystem of OSCAR via computer terminals. The RO is responsible for entering all Medicare initials and terminations unless this has been delegated to the SA. Nursing homes and home health agencies data must now be entered through ASPEN Central Office (ACO) by SAs and ASPEN Regional Office (ARO) for ROs. The data will move from ASPEN to OSCAR. Entered deficiency data is compared against a list of critical requirements (flags) in order to identify surveys that require submittal to the RO by the SA for substantive professional review prior to approval for continued program participation. After a compliance determination is made, additional information is entered into the system to complete the certification record. Standard reports are available from OSCAR and can be produced on an as-needed basis. User designed reports can be set up and saved in a user library for future use. Each standard and user designed report pertains to a particular aspect of the certification process. The intended use of these reports is to help SAs understand and manage their workload and identify processing problems for correction. 4149B - Availability of OSCAR Data (Rev. 1, 05-21-04) Provider information abstracted from the certification documents is maintained in OSCAR data records and produced in various formats to assist the SA, RO, and CO in managing and assessing their respective areas of responsibility in the certification process. It is the responsibility of each SA, the ROs, and CO to generate the reports necessary to monitor and manage their certification workload. The SA/RO should generate OSCAR Report 2 (Facilities Scheduled for Survey) on a regular basis for those provider/supplier types currently being surveyed on an annual basis. They should obtain history profile of deficiencies for these facilities by running OSCAR Report 3 (Facility History Profile). Here, they can target their search on Condition, standard, lesser requirements, or all deficiencies. Other OSCAR reports that would be useful to the SA, RO, or CO and can be generated on an as-needed basis are: • OSCAR Report 9 (Average Certification Work Processing Times) which calculates the average processing times to complete the certification of each category of participating providers and suppliers; • OSCAR Report 9R (Recap of Certification Work Processing Times) compares the average processing times by certification processing steps and type of certification action; • OSCAR Reports 18 through 20 provide a Comparison of Deficiency Patterns by tag number sequence, by State, region, and frequency of occurrence. This information is displayed either by State, region, and nation; and • OSCAR report 5 and 6 provide a listing of all Medicare/Medicaid facilities in alphabetical order by type of facility, chronological survey date order, zip code, or State region code. Through the user defined features of OSCAR, users can customize and design their own reports as well as extract data and download that data to a PC where it can further be analyzed with the available PC tools. OSCAR has on-line information retrieval. Its inquiry option provides the ability to search by name, provider number, provider type, or ZIP code. 4149C - Review of Certification Data (Rev. 96, Issued, 12-13-13, Effective: 12-13-13, Implementation: 12-13-13) It is crucial that the SA and RO review all certification documents for completeness and accuracy prior to data entry to maintain the integrity of the OSCAR database. To avoid processing delays, make sure the appropriate forms, as listed below, are at hand. The ODIE and ACO systems are programmed to accept data from complete certification kits that contain all required forms. Some documents are common to all initial and recertification kits including the “Medicare/Medicaid Certification and Transmittal” (Form CMS-1539), the appropriate Request for Certification form, the “Statement of Deficiencies and Plan of Correction” (Form CMS-2567), and the Crucial Data Extract (CDE). The SA and RO may enter the data from the “Post-Certification Revisit Report” (Form CMS-2567B) detailing the status of the deficiencies on the revisit either at the time of initial data entry or, if the facility record is already in OSCAR, at a later time. The CDE must be present in every kit. The CDE for each type of institution corresponds to the respective Survey Report and abstracts certain compliance and deficiency information for data collection purposes. The following list includes all the basic certification documents (including their provider number series that follows the 2-digit State code) required for ODIE or ASPEN Central Office input in all routine initial and recertification packages: (See also §2779.) 1. Nonaccredited Acute Hospital (0001 to 0879) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Request to Establish Eligibility,” Form CMS-1514 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • Crucial Data Extract for Form CMS-2786 • “Survey Team Composition and Workload Report,” Form CMS-670 2. Nonaccredited Psychiatric Hospital (4000 to 4499) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Request to Establish Eligibility,” Form CMS-1514 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • Crucial Data Extracts for Form CMS-2786 • “Survey Team Composition and Workload Report,” Form CMS-670 3. Accredited Acute Hospital (0001 to 0879) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Request to Establish Eligibility,” Form CMS-1514 4. Accredited Psychiatric Hospital (4000 to 4499) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Request to Establish Eligibility,” Form CMS-1514 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • “Survey Team Composition and Workload Report,” Form CMS-670 5. Home Health Agency (7000 to 8499 and 9000 to 9499) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Home Health Agency Survey and Deficiencies Report,” Form CMS- 1572(A) • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • “Survey Team Composition and Workload Report,” Form CMS-670 6. Portable X-Ray (X0000001 to X9999999) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Request to Establish Eligibility,” Form CMS-1880 • “Portable X-Ray Survey Report,” Form CMS-1882 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • “Survey Team Composition and Workload Report,” Form CMS-670 7. Rehabilitation Agency (OPT/SP) (6500 to 6989) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Request to Establish Eligibility,” Form CMS-1856 • Crucial Data Extract for Form CMS-1893 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • “Survey Team Composition and Workload Report,” Form CMS-670 8. Rural Health Clinic (3400 to 3499, 3800 to 3999 and 8500 to 8999) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Request to Establish Eligibility,” Form CMS-29 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • Crucial Data Extract for Form CMS-30(E) • “Survey Team Composition and Workload Report,” Form CMS-670 9. ESRD (2300 to 2999 and 3500 to 3799) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • Crucial Data Extract for Form CMS-3427 • “Survey Team Composition and Workload Report,” Form CMS-670 10. SNF and SNF/NF - Titles XVIII and XVIII/XIX (5000 to 6399) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Long Term Care Facility Application for Medicare/Medicaid,” Form CMS-671 • “Resident Census and Conditions of Residents,” Form CMS-672 • “Statement of Deficiencies and Plan of Correction,” Form CMS- 2567 • “Fire Safety Survey Report Crucial Data Extract,” Form CMS-2786 • “Survey Team Composition and Workload Report,” Form CMS-670 11. NF (A001 to A999, 00-B001 to B999, E001 to E999, and F001 to F999) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Long Term Care Facility Application for Medicare/Medicaid,” Form CMS-671 • “Resident Census and Conditions of Residents,” Form CMS-672 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • “Fire Safety Survey Report Crucial Data Extract,” Form CMS-2786 • “Survey Team Composition and Workload Report,” Form CMS-670 12. Intermediate Care Facilities for Individuals with Intellectual Disabilities (GOO1 to G999, H001 to H999) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Intermediate Care Facility for Individuals with Intellectual Disabilities Survey Report,” Form CMS-3070G • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • “Fire Safety Survey Report Crucial Data Extract,” Form CMS-2786 • “Survey Team Composition and Workload Report,” Form CMS-670 13. Ambulatory Surgical Centers (C0000001 to C9999999) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Ambulatory Surgical Center Request for Certification in the Medicare Program,” Form CMS-377 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • “Ambulatory Surgical Center Survey Report,” Form CMS-378 and “Ambulatory Surgical Center Report -- Crucial Data Extract,” Form CMS-378E • “Fire Safety Survey Report,” Form CMS-2786H • “Survey Team Composition and Workload Report,” Form CMS-670 14. Comprehensive Outpatient Rehabilitation Facilities (4500 to 4599, 3200 to 3299, 4500 to 4599 and 4800 to 4899) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Request to Establish Eligibility,” Form CMS-359 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • “Survey Team Composition and Workload Report,” Form CMS-670 15. Hospice (1500 to 1799) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Request to Establish Eligibility,” Form CMS-417 • “Statement of Deficiencies and Plan of Correction,” Form CMS-2567 • Crucial Data Extract for Form CMS-643 • “Survey Team Composition and Workload Report,” Form CMS-670 16. Community Mental Health Centers (4600 to 4999 and 1400 to 1499) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • “Community Mental Health Center Crucial Data Extract (No CMS number.) 17. Federally Qualified Health Centers (1800 to 1989) • “Medicare/Medicaid Certification and Transmittal,” Form CMS-1539 • Federally Qualified Health Center Crucial Data Extract 18. CLIA Laboratories (D0000001 to D9999999) • “Medicare/Medicaid Certification and Transmittal Form CMS-1539 • “Survey Report Form (CLIA),” Form CMS-1557 • “Statement of Deficiencies and Plan of Correction,” Form-2567 • “Survey Team Composition and Workload Report,” Form CMS-670 4149D - OSCAR Input Considerations (Rev. 1, 05-21-04) After the kit is reviewed to ensure that the appropriate certification documents are complete and the data is entered into ODIE or ACO, it undergoes a series of edit and consistency checks programmed into the system to screen input errors and data inconsistencies. Depending upon the nature of the error, the data may be rejected or placed in a pending transaction file until corrected information is received and accepted to the record. To assure efficient operation of the system, the SA should be careful that all certification data are completed properly, keyed accurately, and transmitted promptly. 4149E - Suggested Output Utilization (Rev. 1, 05-21-04) 1 - SA The SA produces the OSCAR reports identified in subsection B on a regular basis. These reports provide pertinent information concerning the ongoing management of the certification process. The SA uses these as tools in monitoring the status of individual providers and suppliers in the State. Preliminary analysis of facility deficiency profiles (OSCAR Report 17) can help the SA determine the appropriate survey team composition for resurveys. The survey team can use the profiles to familiarize themselves with the histories and characteristics of facilities scheduled for forthcoming surveys based on previous findings and reported corrective actions. For HHA and NH surveys, surveyors should also review the appropriate quality indicator and quality measures reports. OSCAR Report 2 can be utilized to verify internal controls and existing records for scheduling resurveys. Additional management information can be derived from OSCAR Report 5 or 6 since each lists all participating providers and suppliers in alphabetical order by facility name for reference purposes. Also, OSCAR Report 5 or 6 can sort the facilities by provider number order, zip code, or State region code. These reports should help the SA maintain a balanced survey schedule and avoid certification backlogs. The SA, through careful analysis of OSCAR Reports 18 through 20, can uncover significant State deficiency patterns and reflect a possible need for additional surveyor training or provider consultation in problem areas. The SA can then investigate the causative factors that underlie frequently occurring deficiencies and institute plans for corrective action. Similarly, if a State consistently shows few deficiencies for requirements often out of compliance nationwide, it can explore whether the facilities are strong in that area or if there are problems with the survey process. OSCAR reports may also be used to track selected deficiencies over a specified time period and enable the SA to monitor any changes in deficiency patterns. 2 - RO Usage Evaluation of SA performance is the most important responsibility of the RO and use of OSCAR data is an integral part of this evaluation. Analysis of data derived from the various OSCAR reports can provide the RO with insights into such areas of SA performance as timeliness of certification actions (OSCAR Reports 9 and 9R) and facility deficiency patterns as compared to other States, regions, and the nation (OSCAR Reports 18-20). OSCAR reports can specifically provide the RO with the tools to: • Identify overdue recertifications; • Prepare for SA visits; and • Monitor SA processing times. 3 - CO Usage CO calls upon OSCAR to answer informational requests from interested parties (e.g., Congress, public interest groups, governmental agencies) and to supply statistical information to the Administrator of CMS. The data from OSCAR is also used extensively in the general oversight of the certification process on the national level.