Medicare Compliance & Reimbursement

 What SNFs need to know now.

To protect themselves from compliance problems, SNFs should take these steps to audit their own quality of care and policy compliance:

1. Recognize a need. "The first step for many nursing homes is to recognize that their [business] interests need protection," says Reta Underwood, president of Long Term Care Consultants, Inc. in Louisville, KY. Many nursing homes may have a false sense of security, agrees Joanne Lax, an attorney with Dykema Gossett in Bloomfield Hill, MI. Even though long-term care is known as a highly regulated industry, enforcement of those regulations has lacked muscle in recent years.
 
Consequently, providers have become accustomed to a longstanding trend toward relatively weak sanctions for noncompliant facilities. "Prior to the 1990s there were no fines associated with deficient facilities - and since then fines are often collected only after years of litigation," Underwood explains. But all that has changed.
 
2. Be realistic. "There's a certain amount of corporate protection that goes on," suggests Underwood. That is, a senior manager may not want to believe the situation at a facility is as bad as it is. Say a nursing home has implemented a "new and improved" system for pressure ulcer prevention and treatment. That's great, if the system is working. What happens in too many cases, say experts, is that staff take too long to get up to speed, creating interim compliance problems that could be more serious than before the new program launched. "It's not enough to say you have a new system in place," clarifies Underwood. "You have to have a new system that is working."
 
Even facilities that did well on their last survey should be vigilant, says Underwood.
 
Another problem: Short-staffed state survey agencies could miss problems that will haunt a facility when the next survey rolls around. By then, bad habits will be ingrained - and government surveyors could have plenty of evidence of a long history of noncompliance.

 3. Be prepared. SNFs may not know precisely when surveyors will knock next, but they can take advantage of what Underwood calls a "window of opportunity." Staff should be ready for surveyors no later than nine months following their last survey, she advises, which is typically the earliest the next annual survey will take place. The survey may not happen until 15 months after the last survey was completed, but being prepared from the onset will go a long way toward steering clear of costly sanctions.

 4. Tackle the two Ts: turnover and training. SNFs' high turnover rates mean they face an incredible challenge in staying current on staff's required in-service training. "There's a long list" of topics that need to be covered, reminds Underwood.

 5. Conduct compliance audits on a regular basis, advises Underwood - and then confirm your findings with a third party audit.
 
Basic audit: Pull the charts and related records for about 10 percent of residents, at random, suggests Underwood. At a minimum, review the MDS, medical records including medication administration records, treatment administration records, physicians' orders and a med cart review. Note and immediately address discrepancies, especially those that suggest a pattern of noncompliance.