Home Health & Hospice Week

Eliminate a record of your overturned deficiencies with this advice from CMS.

This summer will bring alternative sanctions like CMPs and payment suspensions to home health surveys, but also one beneficial new option — informal dispute resolution. Employ these tips to use IDR to your advantage:

• Make the deadline. When you receive your statement of deficiencies, you have 10 calendar days to appeal, noted Centers for Medicare & Medicaid Services’ Pat Sevast at the National Association for Home Care & Hospice’s annual meeting in Washington, D.C. You also have those same 10 days to file your IDR request, CMS notes in the 2013 home health prospective payment system final rule published in the Nov. 8, 2012 Federal Register. "The HHA’s request for IDR … should be submitted within the same 10 calendar day period that the HHA has for submitting an acceptable plan of correction," CMS says.
•  Include the required info. "The HHA’s request for IDR must be submitted in writing [and] should include the specific deficiencies that are disputed," CMS says in the rule.

Remember: IDR is for condition-level deficiencies only, Sevast stressed. IDR won’t apply to standard-level deficiencies.

• Focus on components. IDR is for condition-level deficiencies only. But if you can get one of the standard-level pieces of the condition-level deficiency overturned, you might be able to bump the condition-level citation down to a standard-level, Sevast pointed out in her Nov. 1 talk at the conference. Often, multiple standard-level violations add up to a condition-level citation. If you can knock out a standard, you may negate the cumulative effect and get the condition overturned.

Bottom line: If you’re appealing the condition, you would want to address all the standards for that condition," Sevast suggested.

• Pursue appeals simultaneously. Using IDR doesn’t mean you should put an appeal on hold. The appeals clock continues to tick regardless of IDR. If you don’t get the deficiency reduced or knocked out in IDR, you’ll have lost your chance to appeal.
• Request a new 2567. If you succeed with your IDR, you shouldn’t rest yet, Sevast advised. Instead, ask for the state survey agency to issue you a new Statement of Deficiencies and Plan of Correc-tion (Form CMS-2567).

Why? In the Automated Survey Processing Environment (ASPEN) computer system CMS uses to keep track of survey information, 2567 forms are subject to Freedom of Information Act (FOIA) re-quests, Sevast revealed. If anyone requests your survey record under FOIA, they will receive a complete survey with the overturned deficiencies struck through. If you get a new 2567, it will completely replace the old one in the system.

Drawback: You will have to complete a new plan of correction if you request a new 2567, Sevast pointed out.