OASIS-E (CMS) · CMS
Outcome and Assessment Information Set. Standardized data elements integrated into comprehensive assessment for Medicare home health patients. Includes socio-demographics, functional status, health conditions, and service utilization. Used for quality reporting and payment (PDGM).
Auto-fill 40% of fields from your profile. Save 65 minutes. Download a real PDF.
Submit electronically to CMS through the QIES ASAP system
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInitsHome health agencies must transmit OASIS data to the state survey agency within 30 days of assessment.
Filing Deadline
Start of care: within 5 days of admission. Recertification: every 60 days. Transfer/discharge: within 2 days of the event. Resumption of care: within 2 days.
Electronic submission: processed within 24-48 hours by the state system. CMS uses OASIS data for prospective payment, quality reporting, and outcome measures.
CMS processes OASIS data to calculate the Home Health Resource Group (HHRG) for prospective payment. OASIS data also feeds into Home Health Compare quality ratings. The agency receives payment based on the PDGM (Patient-Driven Groupings Model) classification.
CMS-485 · CMS
Documents the home health treatment plan including diagnoses, medications, services ordered, frequency, and goals. Must be signed by physician. Reviewed and rewritten every 60 days.
F2F Encounter (CMS) · CMS
Required documentation of a face-to-face encounter with the patient within 90 days before or 30 days after the start of home health. Must document homebound status and need for skilled services.
HHA Authorization (agency-specific) · Home Health Agencies
Authorization and care plan for home health aide services. Documents specific tasks the aide may perform, schedule, and supervisory requirements. RN supervisory visits required at least every 14 days.
Tell our assistant about your situation and we'll find the right forms for you.
Chat with Form AssistantDisclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the CMS or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.
© 2026 BeneFill. All rights reserved. BeneFill™ is a trademark of Elevens.ai LLP.