Certification and Recertification by Physicians for Extended Care Services

  In skilled nursing facilities, in accordance with CMS manual guidance, CMS will only make payment for covered post-hospital extended care services if a physician makes the required certification and, where applicable, the required re-certification regarding the services furnished. Skilled nursing facilities are responsible for obtaining the required physician certification and recertification statements. Such certification must clearly note that that post-hospital inpatient extended … [Read more...]

Common Nursing Facility Survey Deficiencies

McKnights Long Term Care News offers a free webinar entitled "2012 Survey Update: The Least You Need to Know" on common nursing facility deficiencies. Linda Elizaitis, president of CMS Compliance Group and one of the speakers, stated the most common nursing home citations have to do with kitchen sanitation, infection control, management of resident care plans and medication dispensing procedures. Elizaitis noted that state surveyors have also honed in on matters of resident dignity, and … [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...]

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...]

Background Checks for Nursing Homes and Assisted Living Facility Employees

Many nursing homes and assisted living facilities may be unsure whether they are required to conduct background checks for independent contractors with direct client contact (such as dieticians and medical directors). The question arises because there appears to be a conflict between the Texas Health and Safety Code and a DADS handbook. Under Texas Health and Safety Code Section 250.002, nursing homes and assisted living facilities are required to conduct criminal background checks ONLY on … [Read more...]

New Interpretive Guidance on Quality of Life and Environment

On June 12, 2009, Appendix PP, pertaining to nursing facilities, was revised with regard to F-tags 172, 175, 241, 242, 246, 247, 252, 255, 256, 371, 461 and 463. Here is a copy of the CMS Transmittal detailing the changes: Transmittal 48 James M. Berklan, editor of McKnight's Long-Term Care News says the following about the changes: Uncle Sam has put in his order for a heaping dose of resident choice and flexibility. Here's hoping you have your order pad and pencil at the ready, … [Read more...]

Are You Ready for the Latest Changes to the SOM? Tags 325 and 371

On September 1, 2008, changes within Appendix PP of the State Operations Manual become effective. The changes involve deleting F326 and incorporating that tag's guidance into F325 and deleting F370 and incorporating it into F371. However, the changes are voluminous compared to what exists now. You may find the changes here, comprising 58 pages. The old sections are here and here. The changes concern nutrition, therapeutic diets, approved food sources and food sanitation. Be ready. … [Read more...]

The Fairness in Nursing Home Arbitration Act of 2008

Congress is considering the Fairness in Nursing Home Arbitration Act of 2008, which make pre-admission arbitration agreements invalid and unenforceable. The House Judiciary Subcommittee on Commercial Law and Administrative Law just approved the bill and refused amendments which would prevent it from being applied retroactively, among other things. Specifically, the bill: ...requires that agreements to arbitrate nursing home disputes be made after the dispute has arisen and not at the time … [Read more...]

Provider Letters: National Provider Identifier and Criminal History Checks

April 27 The Texas Department of Aging and Disability Services (DADS) informed nursing facilities, community services, ICF/MR, and therapy providers about the National Provider Identifier (NPI) reporting process. An NPI is a 10-digit number used to identify health care providers. To prevent delays in billing, all providers that contract with DADS are required to report an NPI or Atypical Provider Identifier to DADS before June 1, 2007. For more information, download the letter here. May … [Read more...]