Archive for 'Surveys & Compliance'

Keep Your Eye Out for This IJ Citation Waiting to Happen

Posted on 22. May, 2010 by .

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Just because a nursing home resident doesn’t have an identified risk doesn’t mean you can’t get penalized for it.

How’s this for a survey management twist? Facilities can get hit with F tags for identifying a risk that doesn’t really exist, which means your team needs to make sure residents’ assessment records and documentation are current and accurate.

Cautionary tale: A facility received an immediate jeopardy citation for mistakenly identifying a resident as having a latex allergy.Someone had written that in the resident’s medical record at some point,says attorney Paula Sanders, partner with Post & Schell in Harrisburg, Pa.

Here’s the kicker: The facility didn’t get immediate jeopardy because of the mistaken assessment. Rather, “the facility had no plan in place about what to do to address the patient’s latex allergy,” which is why surveyors called IJ, Sanders explains. The case sets a precedent for a survey agency holding a facility responsible even though “there is no way the person could have been harmed,” says Sanders. In fact, no one in the facility had a latex allergy, she relays.

3 Strategies Keep the Assessment Record Straight

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RUG-IV May Require Revamping Case Management Strategies

Posted on 16. May, 2010 by .

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Home therapy visits could help achieve targeted outcomes under RUG-IV.

RUG-IV will only allocate half of a resident’s concurrent therapy minutes toward placement in a rehab RUG category. And the industry will take some time to figure out if having to split the minutes of concurrent therapy will “produce fallout for facilities coding concurrent minutes,” says Elisa Bovee, OTR/L, director of education and training for Harmony Healthcare International in Topsfield, Mass. Bovee predicts, however, that facilities will “steer away” from providing the modality.

Instead, facilities that have been providing concurrent therapy may use more group therapy — “especially facilities with an influx of admissions and not enough therapy staff to manage it,” she says.

“One case management strategy — if clinically appropriate for the patient — is to move to more group minutes … to meet the patient’s needs and also get in all the therapy minutes. Patients in group therapy are all performing a similar activity,” counsels Bovee.

Providing more rehab therapy home visits to Part A patients can also help achieve therapy outcomes and ensure discharge safety. For details, read “Rehab Therapy Home Visits Can Be the Ticket to Improving Discharge Safety” in MDS Alert, Vol. 8, No. 4,  available online immediately when you subscribe.

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GAO to CMS: Get Tougher on Special Focus Facilities

Posted on 07. May, 2010 by .

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CMS gets poor marks from GAO on enforcement of SFFs.

The Centers for Medicare & Medicaid Services (CMS) should exert more efforts to improve poorly performing nursing homes, as some states have not adhered to the requirements of CMS’s Special Focus Facilities program, the Government Accountability Office (GAO) recommends in a report.

Under the program, states select Special Focus Facilities (SFFs) from among a list of 15 poorest performing nursing homes in each state. These selections then come under strict scrutiny from both the states and CMS, such as being surveyed twice as frequently as other homes, and possibly getting canned if they fail to improve within about 18 months.

What GAO Examined

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Got EMRs? Brush Up on Privacy Basics Before Your Next Survey

Posted on 06. May, 2010 by .

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2 common privacy missteps will translate into F tags.

HIPAA compliance is hot these days. And the best way to stay out of survey hot water for privacy breaches involving electronic health records is to know what surveyors will likely target.

Good and bad news: CMS doesn’t expect surveyors to assess whether EHRs comply with HIPAA privacy and security rules, according to a survey & cert memo on the issue. But the agency does direct surveyors to focus “on how the EHR system is being used in the facility.” Examples include whether facility staff members leave computer screens that display clinical record information “unattended and readily observable and accessible by other patients/residents or visitors.”

Also on surveyors’ hit list …

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Does Staying on Top of DAB and ALJ Rulings Pay Off as a Survey Management Strategy?

Posted on 01. May, 2010 by .

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Doing this instead may provide a bigger bang for your effort.

Questions: How advantageous is it for nursing facilities to review ALJ or DAB rulings in terms of applicability to their own situations? Can you sometimes identify trends by staying on top of rulings?

Answers: Departmental Appeals Board and Administrative Law Judge rulings are of very limited use to facilities, in the view of attorney Joseph Bianculli, in private practice in Arlington, Va. “The Board specifically says that its decisions are fact-specific and not precedential.” And different ALJs may treat the same facts differently, he says. In fact, “two of the five ALJs almost never rule in favor of nursing facilities.”

Bottom line advice …

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Federal Probe Targets Nursing Home Operator for Potential Illegal Referrals to Psych Facility

Posted on 01. May, 2010 by .

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Convicted physician points incriminating finger at nursing home  operator.

The net is widening in a case where a Chicago internal medicine physician was convicted last year for providing kickbacks to other doctors to refer Medicare patients to a private psychiatric facility to which he had ties. The physician is now claiming that a nursing home operator was involved in the same type of arrangement to fill the psych facility’s beds. That’s according to an April 18 article in the Chicago Tribune outlining the U.S. probe into the case. The nursing home operator “vehemently denies the allegations,” the article reports.

The case background reveals …

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Are Your Glucometers Putting Your Nursing Facility at Risk?

Posted on 26. Mar, 2010 by .

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Immediate jeopardy case provides a heads up for all facilities.

If your facility isn’t cleaning its glucometers appropriately, beware. One facility recently got IJ for failing to clean a glucometer in between patients, even though staff had changed the lancet, reports attorney Paula Sanders, partner with Post & Schell in Harrisburg, Pa.

In fact, the revised CMS survey guidance for F441 (infection control) includes a specific IJ example involving that practice. The guidance notes that “not cleaning and disinfecting glucometers between every use and re-using glucometer lancets” creates immediate jeopardy because it potentially exposes multiple residents to bloodborne infections. (more…)

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OIG to CMS: Step Up DPNA Denials

Posted on 22. Mar, 2010 by .

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Two other OIG recommendations target nursing quality of care in SNFs

Fiscal intermediaries are paying claims they shouldn’t, resulting in $5 million in overpayments to nursing facilities, says the HHS Office of Inspector General in its 2010 Compendium of Unimplemented Recommendations.

Formerly called the ‘Red Book’ and the ‘Orange Book,’ the Compendium is the OIG’s annual roundup of actions they’ve asked CMS to take across multiple health care sectors to save money and increase quality of care. The Compendium highlights actions the OIG feels CMS hasn’t fully implemented.

If CMS follows OIG’s recommendations, you can expect the MACs to be tougher on your nursing facility claims. “We found that CMS and its FIs had incorrectly processed 74 percent of DPNA actions,” says the OIG, adding that incorrect DPNA processing resulted in $5 million in overpayments to nursing facilities.

To remedy the problem, the OIG says CMS should:
(1) manage DPNA cases to ensure that DPNA instructions are sent promptly and that Fiscal Intermediaries (FIs) and MACs retrospectively review cases that are processed late to correct any payment errors;
(2) address communication breakdowns by implementing a standard format to notify FIs or MACs that a DPNA remedy will be in effect;
(3) require confirmation that instructions are received and understood; and
(4) update guidance on coding readmissions and verifying readmission status for DPNA claims.

The OIG also expresses concern about the nursing aides working in nursing facilities. The watchdog agency wants to see states properly maintaining nursing aide registries. The OIG also wants updated training curricula for nursing aides.

To read what the OIG has to say about nursing homes, go here, click 2010 and scroll down the PDF to pages 13 thru 17. If your facility has hospice, you’ll also want to check out the OIG’s hospice recommendations on pages 21 thru 23.

These tips prepare your nursing facility staff to interact competently with surveyors, auditors and regulators.

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Watch Out for this IJ Citation Waiting to Happen

Posted on 15. Mar, 2010 by .

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Just because a resident doesn’t have an identified risk doesn’t mean you can’t get penalized for it.

How’s this for a survey management twist? Facilities can get hit with F tags for identifying a risk that doesn’t really exist, which means your team needs to make sure residents’ assessment records and documentation are current and accurate.

Cautionary tale: A facility received an immediate jeopardy citation for mistakenly identifying a resident as having a latex allergy. Someone had written that in the resident’s medical record at some point, says attorney Paula Sanders, partner with Post & Schell in Harrisburg, Pa.

Here’s the kicker … (more…)

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Mariner, Sava Settle Kickback Allegations

Posted on 08. Mar, 2010 by .

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Nursing home executives disguised kickbacks as legitimate transactions and backdated documents, DOJ alleges.

It isn’t the whopping $98 million the nation’s largest nursing home pharmacy chain, Omnicare, paid to settle kickback allegations late last year, but it’s still some hefty cash.

Atlanta-based Mariner Health Care Inc. and SavaSeniorCare Administrative Services LLC have agreed to pay $14 million to settle allegations about their roles in a sprawling scheme involving kickbacks, according to this release from the Department of Justice.

What started the whole mess? A qui tam suit brought by a whistleblower: United States ex rel. Resnick v. Omnicare, Inc., et al., No. 06-10149-RGS (D. Mass.). Last year, Omnicare paid $98 million to settle charges it accepted kickbacks from drugmaker Johnson & Johnson (J&J) to recommend that physicians prescribe Risperdal, an antipsychotic prescribed to nursing home patients. The government alleges that while the kickback scheme between Omnicare and J & J was going on, Omnicare was also paying kickbacks to the two big nursing home chains to induce them to refer their patients to the pharmacy giant.

A big FMV question … (more…)

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