HHSC – Learning Collaborative Summit

HHSC has posted information on the August 27th - 28th Statewide Learning Collaborative Summit, including the livestream link and agenda, on the Dates and Deadlines page. Visit us at Garlo Ward, PC … [Read more...]


  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...]

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...]

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...]

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...]

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...]

Why Should You Have a Compliance Program?

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 PPACA's requirements for nursing facilities are specific, the PPACA also contains broad compliance program requirements for all other … [Read more...]

Institute of Medicine to Conduct Year-Long Study in HIT Safety

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 technology for the Medicare and Medicaid incentive payments program, which CMS will administer.  Also in … [Read more...]

Court’s Texting Decision Shows Importance of Updated Policies

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 unlawful search in violation of the Fourth Amendment to the U.S. Constitution. Quon was a SWAT team police officer who was issued a pager capable of sending and … [Read more...]