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 [...]
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?
April 30, 2012 by Jerri Lynn Ward, J.D.
Filed under Assisted Living, Hospitals, Licensed Health Providers, Medicaid, Medicare, Nursing Homes, Operational Issues, Other Posts, Patient Protection and Affordable Care Act, Quality Assurance
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, [...]
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 [...]
April 14, 2012 by Jerri Lynn Ward, J.D.
Filed under Business, Fraud, General Counsel, Home Health, Hospice, Hospitals, Licensed Health Providers, Medicaid, Medicare, Nursing Homes, Operational Issues, Patient Protection and Affordable Care Act, Physicans
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 [...]
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 [...]
The Patient Protection and Affordable Care Act (“PPACA”) mandates in Sections 6102 and 6401 that a broad range of providers, suppliers, and physicians adopt compliance and ethics programs. By March 23, 2013, skilled nursing facilities and other nursing facilities must have “in operation” a compliance and ethics program that meets the PPACA’s criteria. Although the [...]
Under the HITECH Act of 2009, the Medicare and Medicaid electronic health record (“EHR”) incentive programs provide a financial reward for the meaningful use of qualified, certified EHRs to achieve health and efficiency goals. In July, CMS announced regulations outlining the initial requirements that eligible health care providers must meet to demonstrate meaningful use of certified EHR [...]
The United States Supreme Court considered an employer’s policies on e-mail and texting use in a decision issued on June 17. As reported previously in this blog, City of Ontario v. Quon raised the issue of whether a governmental employer who reviewed the content of text messages sent using an employer-provided pager had committed an [...]
A new type of wage and hour legislation is gaining steam around the country. Although you may not be familiar with the term “wage theft,” chances are good that you’ll be hearing more about it soon. What is wage theft? Generally, the term refers to an employer’s failure to pay wages when they are due [...]