Home Health & Hospice Week

Conduct mock surveys before real ones cost you.

 Surveyors will begin using new penalties for home health agencies in a few weeks, and more drastic sanctions will take effect next summer. Now’s the time to make sure you’re minimizing your risk in regards to the costly punishments.

Consider taking these steps to ward off alter-native sanctions for your next survey:

• Know your surveys. With the stakes for your survey results getting higher, you should bone up on regulations and survey protocol. "Agencies need to be increasingly familiar with the COPs and with the survey process and tools," says Chicago-based regulatory consultant Rebecca Friedman Zuber.

You can find a link to the COPs at www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/homehealth.html and the State Operations Manual at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/index.html?redirect=/surveycertificationgeninfo. The home health survey process information is in Appendix B at www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_b_hha.pdf.

• School managers. "Educating management on how the sanctions work is helpful," suggests attorney Troy Brooks with Brooks Acevedo in Houston.

Making sure administrators know how to handle the survey process is also important, says attorney Robert Markette Jr. with Hall Render in Indianapolis. That goes beyond the technical survey process details to knowing how to interact with surveyors. Be professional and polite; don’t try to argue with surveyors every step of the way, for example, Markette offers. And make sure the administrator is accessible at all times, so she can be on site for the relatively brief window surveyors are there.

Remember: A combination of standard-level deficiencies can add up to a condition-level deficiency, leading to imposition of alternative sanctions, Markette warns.

• Initiate review. Before a surveyor ever darkens your doorstep, you should review yourself to identify compliance gaps and close them, Zuber counsels. "All agencies need to be looking at their own compliance given the increased penalties for failing to do so," she urges. "The tools are there for them to use and these activities fall neatly into the annual agency review and quarterly clinical record review requirements."

"You need to be very heavily focused on survey review" now that the array of alternative sanctions is going into place, Markette believes. "The survey world is going to get a lot rougher for providers."

 • Focus on survey pitfalls. You can spend your compliance resources wisely by focusing on typical trouble areas for HHAs, Markette suggests. Focus on the most frequently cited tags for agencies.

The Home Care Association of Florida provides a list of the deficiencies at http://hcafnews.com/2012/04/05/cms-provides-top-10-home-health-survey-deficiencies-and-oasis-transmission-errors. "Four of the top ten survey deficiencies centered on failure to comply with plan of care requirements, a recurrent theme each year in home health surveys," HCAF notes on its website. "Plan of care failings ranged from absence of plans of care, incomplete plans of care and failure to provide services in accord with the plan of care."

 • Give your compliance plan a check-up. Reviewing COP compliance should be part of your overall compliance plan, Brooks says. If it’s not — or if you don’t have a compliance plan at all, or have one gathering dust on a shelf — now’s the time to initiate or overhaul a comprehensive plan. The OIG offers a link to compliance guidance at http://oig.hhs.gov/compliance/compliance-guidance — scroll down to the 1998 HHA entry.

• Conduct mock surveys. Part of your review process should be periodic mock surveys, Zuber suggests. "Self assessment and mock surveys are easy ways to look at compliance," she tells Eli. "I never can understand why more agencies don’t use them."

A mock survey can help you pin down your level of compliance, Brooks says. "This is certainly a situation in which an ounce of prevention is worth a pound of cure," he offers.

• Prepare for the next wave. The three sanctions going into place this year are small potatoes compared to the CMP and payment suspension sanctions taking effect in July 2014. To get ready, "consider this year as a practice or dry run," advises attorney Marie Berliner with Joy & Young in Austin. Hold yourself to the same standards as if monetary penalties and suspensions were in effect this year, Berliner says.

HHAs "have one year before the effective date for the civil money penalties, suspension of payment of new admissions and the very important Informal Dispute Resolution process," Brooks points out. "It would be prudent to use that year to get everything in order."

That may include allocating more time and budget to survey prep activities, Markette offers.