Category Archives: Rehabilitation

Office of Inspector General Issues Strategic Plan

The Office of the Inspector General (“OIG”) issued a 2014-2018 strategic plan including outlining the visions, goals, and priorities of that office for the upcoming several years. The plan sets forth four goals: 1. Fight fraud, waste and abuse; 2. Promote quality, safety, and value; 3. Secure the future; and 4. Advance excellence and innovation. Each goals is identified with several priority areas that support the stated goal. The report can be found at the OIG’s website http://go.us.gov/WdbV

CMS Proposed Rules for Immediate Jeopardy Situations for Providers Other than SNFs and NFs

In the April 5th Federal Register, the Center for Medicare and Medicaid Services (CMS) proposed new rules relating to immediate jeopardy situations for providers or suppliers that are not Skilled Nursing Facilities (SNFs) or Nursing Facilities (NFs). The proposed rules were published in April of 2013 in the Federal Register and generally apply to the oversight of accrediting organizations, but CMS also proposed a changed to the rule on providers and suppliers, other than SNFs and NFS, with deficiencies. Continue reading

Spring Cleaning – Dust Off Your Compliance Program Manual and Take Some Practical Steps to Reinvigorate Your Program.

Compliance program fatigue is nothing new. Over at least the last 15 years, health care organizations have jumped in head first, put together detailed manuals and taken the plunge. However, reimbursement cuts, quality initiatives, RACs, ZPICs, whistleblowers, physical plant renovations and simply significant industry challenges got in the way of sustaining an efficient and effective compliance effort. Health care organizations have also become desensitized to the barrage of compliance education, enforcement press releases, audits and reviews and other shock-value communications on the importance of regulatory compliance. In that vein, this very article may get lost in the shuffle, although, we hope it doesn’t.

An efficient and effective compliance effort with your organization is extremely important, if only as an insurance policy against government scrutiny. Additionally, the Patient Protection and Affordable Care Act of 2010, H.R. 3590 (“ACA”) includes requirements that CMS implement mandatory compliance program requirements for all providers and suppliers. In a distinct section of ACA, nursing home mandatory compliance programs were given a specific implementation timeline. Continue reading

Deadline to Submit CON Applications in Ohio is Rapidly Approaching

In 2009, House Bill 1 amended the Ohio Certificate of Need (“CON”) laws to permit inter-county relocations of long-term care beds under certain circumstances. Historically, Ohio CON laws prohibited relocating long-term care beds across county lines. Despite this amendment, the process to accomplish an inter-county relocation of beds remains heavily regulated, and in most cases must be commenced during brief windows of time set forth by the Ohio Department of Health. Continue reading

Revised Advance Beneficiary Notice Use Now Required

The revised Advance Beneficiary Notice (ABN) form is now required as of January 1, 2012.  The ABN form is provided to Medicare beneficiaries by providers such as skilled nursing facilities, physicians and others when the provider believes that Medicare may not cover and reimburse the services to be provided.  This notice of noncoverage is provided to the beneficiary and the revised notice Form CMS-R-131 can be accessed through the attached link with additional information on its use.  http://www.cms.gov/BNI/02_ABN.asp

Outpatient Rehabilitation Services: Complying with Documentation Requirements – MLN Fact Sheet Revised

CMS just released a revision to its MLN Factsheet (ICN 905365) –  Outpatient Rehabilitation Services: Complying with Documentation Requirements. The Factsheet is designed to provide rehabilitation providers with education on the  Comprehensive Error Rate Testing program errors related to outpatient rehabilitation therapy services.  It includes information on the documentation needed to support a claim submitted to Medicare for outpatient rehabilitation therapy services.

You can find a copy of the Factsheet here —–> MLN ICN 905365

Health Reform Includes Face to Face Practitioner Encounters for HHAs and DME

The Patient Protection and Affordable Care Act of 2010, H.R. 3590 (the “Health Reform Bill”) includes statutory provisions requiring face to face practitioner encounter requirements for home health certifications and prior to the provision of orders for durable medical equipment.

In the home health context, Title VI, Subtitle E, Section §6407(a) of the Health Reform Bill amends 42 U.S.C. §1395f(a)(2)(c). The amendment adds a condition to the existing conditions for payment.  The new condition provides that prior to making a certification that a patient meets the criteria for Medicare-covered home health services,  the physician “must document that the physician himself or herself has had a face-to-face encounter with the [patient] within a reasonable timeframe as determined by the Secretary’’. At some point in the near future, CMS will likely publish regulations defining “reasonable timeframe”.

In the durable medical equipment context, Title VI, Subtitle E, Section §6407(b) of the Health Reform Bill amends 42 U.S.C. §1395m(a)(11)(B). The amendment adds a condition to the existing conditions for payment.  The new condition provides that prior to providing an order for durable medical equipment under the Medicare program, “a physician, a physician assistant, a nurse practitioner, or a clinical nurse specialist [must have] had a face-to-face encounter with the [patient] during the 6-month period preceding such written order, or other reasonable timeframe as determined by the Secretary.’’ To the extent that CMS wants to redefine the timeframe, it will likely publish regulations in the future.

Additionally, Title VI, Subtitle E, Section §6407(d) of the Health Reform Bill provides that the encounter requirements shall apply to similar home health certifications or orders for durable medical equipment in the Medicaid program.