An essential element of an effective health care compliance plan is the internal investigations policy. Actions by employees, acting in the course and scope of their employment, can subject corporations to civil and criminal liability. Detecting, investigating and remedying such situations are crucial given the regulatory environment under which health care companies operate. The conduct of the investigation itself can exacerbate the situation. Employees subjected to discipline may … [Read more...] about Risk Reduction and the Internal Investigation Policy
Don't forget the September 23, 2013 deadline to comply with the HIPAA mega rule. Focus on the following: Business Associate Agreements Updating "Notice of Privacy Practices" Adding privacy and security changes to policies and procedures Revising your security breach protocol Encrypting as much as possible Educating staff about the new requirements Also, please note that breaches by your business associates and their subcontractors are your responsibility under the new rules. … [Read more...] about HIPAA Alert!!
http://www.youtube.com/watch?v=gAJV7FsoXkg During the exit interview of a RUG review, you will be asked to sign and initial documents. It is very important that you understand what you are initialing or signing. Carefully review the document that you are asked to sign and ask questions if you don’t understand it before you sign or initial. These documents create a record that may become relevant in a Reconsideration or Appeal. Let us discuss the details by first reviewing the … [Read more...] about RUG Reviews: Signing Documents Provided by the Reviewers
http://youtu.be/0My7cUQgW_w 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 … [Read more...] about YOUR RIGHTS DURING A RUG REVIEW
Nursing Homes will be facing a RUG Utilization review in the near future. This review will cover the years from 2008 through 2010 for MDS 2.0 items. What it is and how it works Reviwers select a group of residents from predetermined RUG categories. We have all read how Medicare/Medicaid is going after the therapy RUGs claiming this is the most abused category. However, surveyors are also targeting the ADL RUGs. Any error found for one resident RUG causes the surveyors to … [Read more...] about RUG REVIEWS: HHSC-OIG reviewers are here – help!