In our last alert, we
discussed The Office of the Inspector General (OIG) 2013 Work Plan as it
impacts hospitals and physician practices. There are, however, a number of new
items on the OIG’s list that directly affect nursing homes, hospices, and
home health providers. Providers can expect surveyors to focus on these
items when they conduct surveys for compliance with federal Medicare and
Medicaid requirements. Below are some of the highlights from the OIG’s
of Atypical Antipsychotic Drugs (New)
will assess the administration of atypical antipsychotic drugs in nursing homes
and examine the characteristics of nursing homes that frequently administer
these types of drugs. Nursing homes are advised to review their policies and
procedures related to the administration of antipsychotic drugs to ensure
compliance with state and federal requirements.
Disease Care (New)
will examine whether claims submitted by nursing homes for communicable
diseases meet state and federal requirements and whether patient safety is
adversely affected as a result of the failure to comply with state and federal
Events in Skilled Nursing Facilities (SNFs)
intends to investigate the incidence of adverse events and temporary harm to
Medicare beneficiaries receiving post-acute care in SNFs, identify contributing
factors, determine whether the events were preventable, and estimate the
associated costs to Medicare.
Requirements for Quality of Care
will examine the use of the Residential Assessment Instrument to develop care
plans and any instances of poor quality care, including whether
hospitalizations of nursing home residents were the result of preventable or
manageable conditions. The OIG also intends to identify poorly performing
Practices and Financial Relationships between Hospices and Nursing
plans to conduct a review of hospices’ marketing practices and financial
relationships with nursing facilities, focusing on hospices that have a high
percentage of their beneficiaries in nursing facilities. In a previous report,
the OIG found that 82% of hospice claims for patients in nursing facilities did
not meet Medicare coverage requirements.
Inpatient Care Claims – Review of Hospice Medical Records
intends to review hospice medical records and hospice inpatient care claims to
determine whether they comply with Medicare conditions of participation for
inpatient hospice care.
Encounter Requirements for Home Health Agencies (New)
will investigate home health agencies’ (HHAs) compliance with the statutory
requirement of a face-to-face encounter with a physician (or certain
practitioners) to certify that beneficiaries are eligible for home health
services under the Medicare program. It is important that HHAs comply with the
statutory requirement and that the encounter is documented in the beneficiary’s
of Home Health Aides with Criminal Convictions (New)
will determine HHAs’ compliance with state and federal requirements related to
conducting criminal background checks on HHA applicants and employees.
you have questions about the OIG’s Work Plan, or any concerns regarding your
organization’s compliance with the items in the Work Plan, please contact Rochelle
H. Zapol, a partner in Prince Lobel’s Health
Care Practice and the author of this Alert. You can reach Rochelle
at 617 456 8036 or firstname.lastname@example.org.
Rochelle has extensive experience in Medicare compliance issues and has
assisted post-acute providers in establishing policies and procedures to comply
with Medicare requirements.