News, Skilled Nursing Facility

OIG’s FY17 work plan will investigate quality and Medicare billing accuracies in skilled nursing facilities

The Office of Inspector General’s (OIG) FY17 work plan has been released and its proposed sections align with the new/revised CMS Medicare guidelines. Some of the work plan’s sections promise to address areas of continual concern, such as unnecessary or fraudulent ultra-high therapy claims made by SNFs, while other areas of the plan will address providers’ compliance with the Quality Assurance Performance Improvement (QAPI) program.

To ensure QAPI’s broad requirements are being met in skilled nursing facilities, the OIG will investigate unreported incidences of abuse and neglect of Medicare beneficiaries. These investigations come in response to ongoing reports in other settings that have determined potential cases of unreported abuse and neglect. The agency will also review nursing facilities’ attention to resident care plans when treating potentially preventable conditions (such as a UTI). The agency will investigate facilities with high rates of resident transfers to a hospital.

The OIG plans to further explore whether Medicare beneficiaries who received prospective payments after being admitted to a SNF were in compliance with the system’s requirements. Beneficiaries receiving prospective payments should have undergone a 3-day inpatient hospital stay prior to admission to the SNF and be admitted to the SNF within 30 days of said hospital stay to be compliant.

Additional areas of the plan include a mandatory review of individual State’s procedures for background checks performed on potential long-term care employees, review of State agencies’ timeliness in conducting investigations of immediate jeopardy and actual harm nursing home complaints, and a goal set forth by the agency to spread information about the uses of its SNF Adverse Event Screening Tool released in 2014.

Access the full work plan here.