What are your rights during a RUG Review? It may be an overstatement to say that you have rights as the deck is so stacked against the provider and in favor of the OIG. But, there are a few things to which you are entitled as part of the process of which you should be aware.
First, the OIG is required to give you a letter upon entrance into your facility. This is the signal that the review is beginning. The letter will explain the procedures of the review and will give important information. Ask for the letter if it is not offered to you.
Second, these reviews are covering years past. Some of the records requested by the reviewers may be offsite. In general, you have two hours to produce records that are requested by the reviewers. However, if you can substantiate that the requested records are offsite, you should be entitled to an extension of time to retrieve them. Take advantage of this as providing as many records as possible could prevent allegations of costly errors.
Third, you are entitled to notification of errors as the review proceeds. You need to be in constant contact with the reviewers to insure that they are notifying you of what they are finding so that you can fully understand the basis of the errors and respond with additional documentation.
Fourth, you have the right to provide additional documentation during the review to refute allegations of errors. Always have additional people available to search down documents while one staff member stays with the reviewers.
Fifth, for providing this additional documentation, you have no less than six business hours to obtain the documents. However, the reviewers do not have to make arrangements to stay overnight to receive documents, so if you are not able to produce these documents by the end of business, you will need to mail them to the business address of the reviewers. It is worth doing this and it is important that you keep clear records of what you mail to them.
Sixth, you are entitled to Request a Reconsideration of the findings. I will discuss the details of that in a future training.
Next week, I will discuss the paperwork that the reviewers will ask you to sign and what rights you may have regarding signing them.
