Medicare
A new focus area for 2014 is Medicare Part A
billing by skilled nursing facilities (“SNFs”).
The OIG added this focus area based on the OIG’s belief that SNFs
increasingly billed for the highest level of therapy even though the
beneficiaries’ characteristics remained mostly unchanged. In addition, the OIG contends SNFs billed
one- quarter of all 2009 claims in error, which allegedly caused $1.5 billion
in inappropriate Medicare payments. As a
consequence, in 2014 the OIG will review SNF billing practices in selected
years and describe how SNFs billing
practices have varied between those years.
The Medicare focus areas that are not new in
2014, but will continue from past years include:
(1) Questionable
billing patterns for Part B services during nursing home stays. The OIG will conduct a series of studies to
examine several broad categories of services, such as foot care, provided to
nursing home residents during stays not paid under Part A. The OIG is continuing to focus on this area
under the explicit direction of Congress to monitor Part B billing for abuse
during non-Part A stays.
(2) State
agency verification of deficiency corrections. The OIG will seek to determine whether State
survey agencies verified correction plans for deficiencies identified during
nursing home recertification surveys.
(3) Program
for national background checks for long-term-care employees. The OIG will review the procedures
implemented by participating States for long-term-care facilities to conduct
background checks on prospective employees and providers who would have direct
access to patients. The review is also
supposed to assess the costs of conducting background checks. The Affordable Care Act mandated this review
and the OIG is expected to issue a summary of its findings in FY 2017.
(4) Hospitalizations
of nursing home residents for manageable and preventable conditions. The OIG will attempt to determine the extent
to which Medicare beneficiaries residing in nursing homes are hospitalized as a
result of conditions thought to be manageable or preventable in the nursing
home. The OIG views hospitalizations of
nursing home residents as a preventable cost to Medicare and an indication of
quality-of-care problems on the part of the nursing home.
Other
Some assisted
living facilities provide services to home and community based (HCBS) waiver
recipients. Although Medicaid covers the
cost of HCBS, it does not cover room and board costs. The OIG will continue to focus on room and
board costs associated with HCBS waiver program payments to determine whether
selected states claimed Federal reimbursement for unallowable room and board
costs associated with services provided under the HCBS waiver programs.
Many states, Indiana included, impose state
health-care related taxes on Medicaid nursing home providers to finance a
portion of the state’s Medicaid spending.
The OIG will continue to focus on and review these taxes imposed on
Medicaid providers to determine whether the taxes comply with applicable
Federal requirements.
By reviewing the focus areas identified in
the Work Plan, providers can determine where to focus their compliance program
efforts. If you have any questions
regarding the Work Plan and nursing homes please contact Randall Fearnow at rfearnow@kdlegal.com or Meghan McNab at mmcnab@kdlegal.com.