The Centers for Medicare & Medicaid Services (CMS) just released the 2012 Nursing Home Action Plan; a guide for CMS’ efforts to continue to improve nursing home safety and quality. The plan features 5 actionable strategies, including: enhance consumer engagement; strengthen survey processes, standards, and enforcement; promote quality improvement; create strategic approaches through partnerships; and advance quality through innovation and demonstration. (more…)
Posts Tagged ‘long-term care’
Nursing Home’s Failure to Notify Leaves Beneficiary Not Liable for Custodial Care Services
Authored By: David W. Bufford
A Medicare beneficiary is not liable for custodial care services rendered by a Mississippi nursing home because the facility failed to give adequate notice the services were not covered by Medicare, a federal appeals court panel ruled on October 25. The case (Mississippi Care Center of Morton LLC, Sebelius, 5th Cir., No. 10-60595, Oct. 25, 2011) concerned the application of 42 C.F.R. 411.404, which states a beneficiary is considered to have known custodial care or services that are not reasonable and necessary are not covered services under Medicare, provided the beneficiary received adequate notice the services are not covered under Medicare. (more…)
OIG Publishes 2012 Work Plan
Authored By: Todd J. Selby
On October 5, 2011, the Office of Inspector General (OIG) published its proposed Work Plan for Fiscal Year 2012. As in the past, the Work Plan continues to identify compliance risk areas that subject Medicare and Medicaid providers to audit and enforcement initiatives. The 2012 Work Plan contains several new areas of focus by the OIG that potentially will impact current operating practices of nursing homes and hospices and the relationships between these types of providers. More specifically, areas of increased scrutiny are (i) nursing home compliance plans; (ii) billing patterns of Part B provider services during non-Part A nursing home stays; and (iii) hospice marketing practices and financial relationships with nursing facilities.
The OIG will review Medicare- and Medicaid-certified nursing homes to ensure the implementation of compliance plans as a part of their day-to-day operations. The compliance plans will be reviewed to ensure they contain the required elements of the OIG’s compliance program guidance. Under the Affordable Care Act, nursing facilities must operate a compliance and ethics program to prevent and detect criminal, civil and administrative violations and to promote quality of care. The Centers for Medicare & Medicaid Services (CMS) is charged with overseeing the program and incorporating the requirements into the Medicare Requirements of Participation. CMS also must issue regulations by 2012, and nursing facility providers must have compliance programs in place by 2013.
Billing patterns of nursing facilities and Medicare Part B providers will be scrutinized to confirm that services provided by Part B providers to nursing facility residents during a non-Part A stay are billed directly by suppliers and providers. More particularly, the OIG will analyze podiatry, ambulance, laboratory and imaging services for conformity with this requirement.
Lastly, the OIG will closely examine and monitor hospices’ marketing materials and practices and their financial relationships with nursing facilities. Recently, the OIG reported that a high percentage of hospice claims for services to Medicare Part A-eligible nursing facility beneficiaries did not meet the Medicare coverage requirements. Observations by MedPAC, an independent congressional agency that advises Congress on issues affecting Medicare, suggest that hospices and nursing facilities may be involved in inappropriate enrollment and compensation relationships. Consequently, practices of hospices with a high percentage of their patients in nursing facilities will undergo increased inspection as well as those hospices that aggressively market their services to nursing facility residents.
A complete copy of the 2012 Work Plan can be accessed at http://www.oig.hhs.gov/reports-and-publications/archives/workplan/2012/Work-Plan-2012.pdf
If you have questions or concerns regarding the foregoing or would like additional information, please contact your regular Hall Render attorney, or Todd Selby at tselby@hallrender.com or 317.977.1440; Brian Jent at bjent@hallrender.com or 317.977.1402; or David Bufford at dbufford@hallrender.com or 502.568.9368.
What Risk Categories Mean to Providers and Suppliers
Authored By: David W. Bufford
Earlier this week, we highlighted the implementation by Centers for Medicare & Medicaid Services (CMS) of enrollment revalidations and screening categories, and which categories CMS places certain long-term care providers. It is important for providers and suppliers to understand what each screening category (limited, moderate, or high) entails and be aware of any events which could elevate screening categories. While these posts focus on long-term care providers, the enrollment revalidations and screening categorizations are applicable to all Medicare providers and suppliers. (more…)
Providers Should Anticipate Reimbursement Changes in Debt Ceiling Agreement
Authored By: David W. Bufford
While Congress was able to present the President with a compromised solution to cut Federal spending and raise the Government’s debt ceiling earlier this month, all long-term care providers should anticipate future reimbursement changes. Under the current law, the Budget Control Act of 2011, Medicare and Medicaid are unchanged. However, the Act requires for the creation of a Joint Select Committee on Deficit Reduction, whose members have until November 23rd of this year to find $1.5 trillion in spending cuts. (more…)
Nursing Facilities Reminded to Evaluate Disaster Preparedness
Authored By: David W. Bufford
As record-breaking temperatures scorch the Midwest, long-term care providers are reminded to evaluate their emergency preparation plans. Proper planning can mitigate a situation from a potential disaster to a mere inconvenience. CMS provides a checklist, Emergency Preparedness for Every Emergency, for providers to use to evaluate their current emergency plans.
Federal regulations at 42 CFR § 483.75(m), require that Medicare and Medicaid certified nursing homes have plans and procedures to meet all potential emergencies and train all employees in these emergency procedures. Nursing home disaster plans are currently included in the OIG Work Plan for 2011, so administrators can expect increased scrutiny of their facility’s disaster plan.
Should you have questions, please contact Todd Selby at 317.977.1440 or tselby@hallrender.com, Brian Jent at 317.977.1402 or bjent@hallrender.com, David Bufford at 502.568.9368 or dbufford@hallrender.com, or your regular Hall Render attorney.
Topical Index
- Home Health (44)
- Hospice (40)
- Litigation and Risk Management (38)
- Long-Term Care (140)
- Medicaid/Medicare enrollment and regulatory compliance (70)