Home Health & Hospice Week

Surveys get tougher, thanks to GAO.

It happens to the best of home health agencies: You've worked your tail off to get your regulatory and compliance ducks in a row, and you expect to reap the rewards at survey-time.
 
But maybe your surveyor is inexperienced, doesn't know home care or is just plain batty. Whatever the reason, she appears ready to cite you for things you don't agree with. What can you do?
 
That scenario may be on the rise, thanks to the General Accounting Office's charge to surveyors to get tougher on HHAs (see Eli's HCW, Vol. XII, No. 5, p. 34). With the onset of the prospective payment system, "surveys have receded in home health agencies' consciousness," said Chicago-based regulatory consultant Rebecca Friedman Zuber in a March 31 presentation at the National Association for Home Care and Hospice's National Policy Conference in Washington, DC.
 
But surveyors appear to have ratcheted up the survey process, especially in some areas of the country, Zuber warned in her presentation, "The Medicare Home Health Survey - What to Expect & How to Respond."
 
The exit conference is HHAs' best hope for deflecting unfair survey findings, said co-presenter Charlotte Hughes, assistant vice president for regulatory affairs for national HHA chain Gentiva Health Services Inc.
 
The survey formal appeals process is so slow that agencies will be out of business before they can appear in front of an administrative law judge, Hughes warned. "The survey is one of the areas where you don't have a heck of a lot of appeal rights."

The exit conference is agencies' first and best stage of appeal and rebuttal of the surveyor's findings, Hughes told conference attendees. Once the surveyor reports your supposed deficiencies, "they are the very devil" to have rescinded, she commented.
 
Every HHA should follow these survey steps, Hughes advised:

 1. Secure your exit conference. Every agency has the right to an exit conference, but surveyors may try to avoid it, Hughes cautioned. Or they say they'd like to conduct it over the phone, once they get to their offices.
 
Don't fall for that trick, Hughes urged. Once the surveyor has left the premises, your arguments lose validity and you have a harder time making her prove her charges.

 2. Document. You have the right to tape your exit conference, as long as you run two tapes and furnish one to the surveyor, Hughes related.
 
But know when to pick your battles, she added. If your surveyor is vehemently against the idea of taping the conference, you're unlikely to get many helpful details out of her. Instead, you can have multiple clerical personnel take very detailed notes of the conference, if you deem it the wiser course.

 3. Attend. Don't be afraid to make it the more, the merrier. In addition to the administrator, it's a good idea to have the clinical manager, your regulatory consultant if you have one, possibly your attorney if you smell trouble, and anyone else you deem involved in the survey process attend the exit conference.

 4. Get specifics. Now is the time to press the surveyor for specifics on the citations she is planning. If she says two out of the 20 charts she reviewed had no physician's orders, ask her to specifically cite which two, Hughes gave as an example. Then you can check those charts before she walks out the door.
 
And you can ask her to produce the regulation to back up any citations you find questionable.

 5. Get and give clarification. Once you get the specifics, you can show her where she may have overlooked something in the record, or challenge the regulatory basis for a citation. This is where you head off nasty deficiencies by simply showing the surveyor the error of her ways.
 
If you disagree with the surveyor on her interpretation of a regulation, you can request to call her supervisor to discuss the matter, Hughes suggested. Or you can show her your documentation, perhaps interpretive guidelines or letters and clarifications from the Centers for Medicare & Medicaid Services.

 6. Send additional documentation immediately. If you are unable to get the surveyor to back down on a point, send in your documentation on that issue immediately, Hughes advises. It shows you didn't generate it later to cover your tracks.