At the conclusion of the onsite review, the HHSC-OIG nurse reviewer must hold an exit conference with the nursing staff. The Administrator, DON, charge nurse and other leadership of the facility should attend in order to gain a full understanding of the findings by the nurse reviewer.
The nurse reviewer is mandated to provide “formal written notification of all MDS validation findings during the exit process.” You will receive a “List of Reviewed Assessments” listing each person in the reviewed RUG categories, any errors they allegedly found and the RUG changes they made. It is imperative that you ask detailed questions about each item. Ask what the dashes mean and why they are there. The dashes are allegations of errors as well. Find out what they mean and why the reviewers listed them. You should be mentally planning your defenses as you acquire the information.
Also, the State encourages Hospice staff attend the conference to discuss findings specific to hospice patients. If the staff of the Hospice provider attends, that staff will receive notifications as to RUG changes only on the Hospice provider’s patients and will opportunity to ask questions about the changes pertaining to those patients. If Hospice staff does not attend, the Hospice provider will have to wait 15 calendar days for the information, which could set back efforts in providing additional information that could be crucial to preparing a Request for Reconsideration.
At the exit conference you will be asked to sign documents. Please refer to information concerning those documents in the preceding article, Rug Reviews: Signing Documents Provided by the Reviewers.
Next we will discuss the Request for Reconsideration.
