Tag: OIG

Nursing Home Compare lacks relevant information for short-stay patients, evidence suggests

Evidence collected by Harvard researchers Brian E. McGarry and David Grabowski suggests that information provided on the Nursing Home Compare website, a tool created by CMS to inform consumers about the quality of care and services being delivered by skilled nursing facilities and nursing homes through a data-driven, five-star ranking system, is more applicable to […]

Shared Savings Program ACOs reduced Medicare spending by $1 billion, according to OIG report

According to findings reported by the Department of Health and Human Services Office of Inspector General (OIG), accountable care organizations (ACOs) participating in the Shared Savings Program are learning how to achieve greater cost savings over time. The Medicare Shared Savings Program is one of the largest alternative payment models implemented by CMS to reward […]

CMS ordered to impose penalties for incidents of unreported abuse/neglect in SNFs

According to an ongoing review of incidents of elder abuse and neglect in skilled nursing facilities and nursing homes, the OIG determined that problems still remain with the quality of care being delivered and the reporting and investigation of such incidents. Regulations mandate that SNFs ensure that all alleged violations, such as mistreatment, neglect, or […]

OIG updates LEIE database file: Why should LTC providers care?

An updated List of Excluded Individuals and Entities (LEIE) Database file has been released by the Department of Health and Human Services, Office of Inspector General (OIG), including all OIG exclusions and reinstatements made through July 2017. Why do LTC providers need to know about this? The OIG recommends long-term care providers check this list […]

Hospice tip: Understand OIG reports and what CDI can do in response

There have been four recent OIG reports specifically reviewing hospice compliance. The OIG Report entitled “Medicare hospices have a financial incentive to provide care in assisted living facilities,” published in January 2015, revealed that Medicare payments in assisted living facilities more than doubled in five years (2007–2012), care provided was for longer periods, and diagnoses […]

CMS welcomes feedback on proposed case-mix rule, extends comment deadline

The Centers for Medicare & Medicaid Services (CMS) has extended the comment deadline for the advance notice of proposed revisions to case-mix methodology rule from June 26, 2017 to August 25, 2017. The advance notice of proposed rulemaking, titled “Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities: Revisions to Case-mix Methodology,” was published […]

Supplemental medical review contractor will focus on hospice

The Centers for Medicare & Medicaid Services (CMS), in response to a recent Office of Inspector General (OIG) report, is directing StrategicHealthSolutions to serve as a supplemental medical review contractor (SMRC) to conduct a post-payment review of hospice claims. The review aims to identify general inpatient level of care claims for the calendar year 2015 […]

Congress reintroduces bill to count observation stays as three-day prerequisite for SNF coverage

Congress has reintroduced a bill that would ensure patients receiving hospital care under “observation status” could count that time as part of the three-day inpatient hospital stay required to receive skilled nursing care coverage under Medicare. The Improving Access to Medicare Coverage Act of 2017 (HR 1421) mirrors a similar bill introduced in 2015. In […]

OIG updates LEIE Database: Why should LTC providers be aware of this?

An updated List of Excluded Individuals and Entities (LEIE) Database file has been released by the Department of Health and Human Services, Office of Inspector General (OIG), including all OIG exclusions and reinstatements made through February 2017. Why do LTC providers need to know about this? The OIG recommends long-term care providers check this list […]

Obstructing audits could now result in providers’ exclusion from Medicare and Medicaid

A new rule published on the federal register today by the Department of Health and Human Services (HHS) states that all individuals and entities convicted of interfering with or obstructing audits and investigations may face exclusion from Medicare and Medicaid. The HHS Office of Inspector General will be limited to a 10-year timeframe to pursue […]