CMS announced several updates to Nursing Home Compare (NHC) that will take place this April, including a removal of the freeze placed on health inspection star ratings instituted in February 2018. The freeze was placed to give all facilities a chance to be surveyed at least once under the new process. Beginning in April, consumers will be able to see the most up-to-date status of a facility’s compliance on NHC.
The Office of Inspector General’s (OIG) studies can serve as a good alert system for long-term care facilities as well as the regulators who monitor them. We’ve compiled a list of relevant reports and recommendations published by the OIG in 2018 to help you prioritize your quality and compliance goals for this year.
Did you know that as a member of the Billers’ Association for Long-Term Care, you get a discount on HCPro boot camps? Our instructors bring best-in-class compliance education to your facility so your entire team can benefit.
A list of facilities with potential staffing issues is being provided to CMS regional offices and state survey agencies to support survey activities for evaluating sufficient staffing, according to a memo released by CMS back in November, 2018. The memo states that “while CMS is encouraged by facilities’ efforts to improve staffing,” payroll based journal (PBJ) data has raised a few concerns, prompting them to inform state survey agencies of facilities with potential staffing issues. These issues include facilities with significantly low nurse staffing levels on weekends and facilities with several days in a quarter without an RN onsite.
By now, most organizations have identified a compliance officer, set up a reporting hotline for staff to report concerns, and done some training with staff on the elements of their facility’s specific compliance and ethics plan to meet the November 28, 2019 implementation deadline.
Providers are encouraged to check the US Department of Health and Human Services, Office of Inspector General’s (OIG) updated List of Excluded Individuals and Entities (LEIE) database file to ensure that excluded individuals are not working in their facility, consequences of which could result in significant fines. The database was updated on December 10, 2018, and does not include individuals and entities that have been reinstated to the federal health care programs.
This quarter’s Billers’ Association for Long-Term Care white paper includes several key case studies from HCPro’s content library that provide solutions to common challenges that SNF billing professionals face, as well as guidance for sharpening billing skills and processes.
SNFs must provide quality care to residents in a field that is being suffocated by regulation and paperwork, and that is placing ever-increasing importance on data. The key is to ensure the data does not eclipse the care. SNFs must adhere to the principle that putting residents first will improve quality measures, increase reimbursement rates, and ensure a successful survey. Enhancing resident care will then give a facility the reputational excellence it needs to fill its beds.
While touting the need for partnership between states and the federal government, the Centers for Medicare & Medicaid Services announced Tuesday that it will carry out a slate of strategies to keep state Medicaid programs from overspending.
Most audits are conducted in very similar manners. They also determine their focus using very similar techniques. Recovery Audit Contractors (RAC) are announcing their focus for complex reviews on their websites. The main difference between them is what they are specifically looking for. These examples are taken from various real-life scenarios and potential scenarios.