Medicare Compliance & Reimbursement

Ignoring these 5 regulatory hot spots could be disastrous.

The spotlight on quality of care in nursing homes just got brighter - and looking the other way would be a huge mistake for skilled nursing facilities.

That's the message that many providers are taking away from the new work plan from the HHS Office of Inspector General, released Oct. 12. The feds continue to focus strongly on nursing home quality, even in the aftermath of the Medicare Prescription Drug Improvement and Modernization Act.

But the feds may not be rushing to action on all fronts - the work plan revisits several stalled long-term care goals from the 2004 plan, notes attorney Marie Infante of Mintz Levin Cohn in Washington. Even so, providers can expect a watchful eye - and action - on a variety of issues. What can providers expect? A tougher survey process, a louder call for compliance with consolidated billing requirements, and the promise of stricter enforcement of sanctions against poor performing nursing homes.

Bottom line: Medicare- and Medicaid-certified facilities need to step up efforts to improve care. Poor performers that don't may be subject to stricter enforcement actions, including denial of payments and civil monetary penalties, suggests Joanne Lax, an attorney with Dykema Gossett in Bloomfield Hills, MI.

SNFs can keep their cool - and their hard-earned cash - by keeping their eyes on the following concerns: 1. Resident assessment. Smart providers will read up on resident assessment shortcomings identified by DAVE, the Data Assessment and Verification project championed by the Centers for Medicare & Medicaid Services. The feds pledge to remain focused on lessons learned during CMS' recent review of facilities' accuracy on the Minimum Data Set (MDS).

Two OIG work plan topics center on resident assessment. The new "Nursing Home Resident Assessment and Care Planning" entry promises a fresh look at the severity of deficiencies related to assessment and care planning. And the revisited call for "Nursing Home Compliance with Minimum Data Set Reporting Requirements" reminds providers that the MDS is "one of the primary mechanisms for addressing residents' quality of care."

Look for: A renewed focus on accuracy of resident assessment and MDS coding, as well as attention to providers' ability to file assessments in a timely manner, suggests Pam Manion, a corporate nurse with Delmar Gardens in Maryland Heights, MO. Pressure from CMS on states where surveyors have been lax will mean a more formidable regulatory burden for providers.

How to prepare: Step up training on resident assessment and MDS coding, including a review of the findings from the latest DAVE bulletin.

To view the bulletin, go to www.cms.hhs.gov/DAVE.asp.

2. Reimbursement. Essentially, CMS seems to be saying "show me the money," suggests Infante. She notes, for example, the [...]