Charting by exception is the single most problematic form of nursing charting. Charting by exception is a tool used for residents who require little to no nursing intervention or care. This type of charting, if not done correctly, will leave the facility subject to allegations of RUG review errors. Reviewers scrutinize nurse charting to determine if it supports flow sheets and checklists. Since MDS 3.0 requires clearly documented comments, charting by exception will be a basis for … [Read more...] about CHARTING BY EXCEPTION–THE FAST TRACK TO RUG ERRORS?
DRILLING DOWN TO ADL MDS ERRORS: THE HOW AND WHY MONEY IS WALKING OUT YOUR DOOR
As discussed last week, ADL's are the major target for HHSC-OIG. ADL's are the source for most errors resulting in RUG write downs. Not only did the facility lose money on incorrectly charted ADL's they will also face large penalties after a RUG review. Charting ADL's For most MDS nurses, ADLS are pieces of paper the CNA's have scribbled some numbers on. Ideally this number reflects both the Plan of Care and what care was really given. Calculating an accurate ADL score for … [Read more...] about DRILLING DOWN TO ADL MDS ERRORS: THE HOW AND WHY MONEY IS WALKING OUT YOUR DOOR
Medicaid and Managed Care–Who Benefits?
Is Medicaid really broke? If not, who is making money where Managed Care is involved? According to this, not the providers. Is this ignored so that attention is focused on allegations of fraud by providers? … [Read more...] about Medicaid and Managed Care–Who Benefits?
Rise of Accountable Care Organizations Changing the Landscape of Accreditation
According to a recent article in Modern Healthcare, increasing consolidation in the healthcare sector and changes in reimbursement methodologies, such as the payment structure for accountable care organizations ("ACOs") is leading to changes in accreditation standards. John Burke, the CEO and President of Accreditation Association for Ambulatory Health Care, stated, "The movement to accountable care organizations and other recent trends has led to more health systems reabsorbing primary-care … [Read more...] about Rise of Accountable Care Organizations Changing the Landscape of Accreditation
Non-payment for “Never Events”: Coming to a Long-Term Care Provider Near You
Since October 2008, the Centers for Medicare and Medicaid Services ("CMS") have not paid hospitals for certain hospital-acquired conditions. That is, CMS will not pay for certain conditions that were not present in the patient upon admission. The conditions are, as designated by CMS, conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been … [Read more...] about Non-payment for “Never Events”: Coming to a Long-Term Care Provider Near You
Social Media and Your Health Care Organization
A new study on social media and health care shows that more than 1, 200 hospitals participate on 4,200 social networking sites. Social media is changing the nature of healthcare interaction, and health care organizations that ignore this virtual environment may be missing opportunities to engage consumers. From a marketing perspective, health care organizations and small businesses should seize the opportunities to capitalize on social media. However, social media in health care is not … [Read more...] about Social Media and Your Health Care Organization
OIG Launches Compliance 101 Website
On March 5, 2005, the Office of the Inspector General ("OIG") launched its Compliance 101 website. The website contains links to guidance and educational training materials for health care providers, practitioners and suppliers. The site contains segment-specific compliance guidance for nursing facilities, ambulance suppliers, physician practices, etc. Although the materials are from 1998-2008, the compliance program guidance is still relevant and details the high-risk areas for each health … [Read more...] about OIG Launches Compliance 101 Website
Protecting Your Business Against Solicitation is More Important Now Than Ever
The Department of Aging and Disability Services (“DADS”) recently initiated the repeal of administrative code sections prohibiting solicitation of another provider’s community services contracts. Prior to January 2012, 40 Texas Administration Code §49.19, entitled “Advertising and Solicitation of Clients,” prohibited certain activities related to a provider's soliciting prospective clients from other providers. The repeal became effective January 25, 2012. DADS previously noted in Information … [Read more...] about Protecting Your Business Against Solicitation is More Important Now Than Ever
Four Habits of High-Value Health Care Organizations
The New England Journal of Medicine recently published an article regarding four habits of effective hospitals. Although the article is geared towards, hospitals, the principles below are applicable to any health care organization. Specification and planning - Base choices, transitions, subgroups, and patient pathway on specific, meaningful criteria. Infrastructure design - Create microsystems to meet the needs of patient sub-populations. The author stresses that microsystems create "an … [Read more...] about Four Habits of High-Value Health Care Organizations
Fall 2011 OIG Semiannual Report to Congress
The Office of the Inspector General ("OIG") recently issued its semiannual report for the period ending September 30, 2011. The report provides an overview of the enforcement actions over the past year. Of particular interest is the report's section of hospice care. Hospice care for nursing facility residents has grown nearly 70% since 2005. The OIG recommends that CMS monitor hospices that depend heavily on nursing facility residents and modify the payment system for hospice care in nursing … [Read more...] about Fall 2011 OIG Semiannual Report to Congress
