THE
SURVEYOR
I FALL 2013
PROGRAM UPDATES
[
HOME HEALTH ]
[
The Centers for Medicare and Medicaid Services (CMS) recently
stated that the Home Health & Hospice Aide Plans of Care CANNOT
use “PRN” or “per patient request” for ANY task, whether specifying
personal care or non-personal care.
Use of “PRN” or “per patient request” in a patient record must be
cited as a def iciency during an on-site survey.
Multiple types of care can only be used when it has been
documented by the nurse that the patient/caregiver has the
ability to functionally and cognitively make the choice.
Aide Plans of Care must be individualized and refrain from using
blanket statements like “patient is cognitively and functionally
able to make the choice” for all patients and tasks.
If patients are requesting a specific type of care as a result
of changes in their condition, Aides must still contact their
supervisor prior to administering care.
For additional information about this update please see
achc.org/CMS.
[
HOSPICE ]
The 2013 work plan released by the Office of the Inspector General (OIG)
highlights two areas of focus to reduce fraudulent or inappropriate
claims:
Marketing practice and financial relationships with nursing facilities
The OIG recently found that 82% of hospice claims for
beneficiaries in nursing facilities did not meet Medicare coverage
requirements. Accordingly, hospice facilities with a high census of
patients whose care is provided in a nursing facility will be under
close scrutiny.
General Inpatient Level of Care
The OIG reports that 27% of hospice organizations billing
Medicare did not meet the Condition of Participation
mandating that this type of care be provided. The OIG
will be scrutinizing the appropriateness of hospice
General Inpatient Level of Care claims.
8
I 855-YES-ACHC (855-937-2242) I
achc.org
achc.org
PRIVATE DUTY ]
MANDATORY ACCREDITATION FOR NC PRIVATE DUTY
PROVIDERS
By June 1, 2014 all Private Duty agencies providing
skilled nursing services must be accredited to be in
compliance with Clinical Coverage Policy No. 3G issued
by the North Carolina Division of Medical Assistance
for Private Duty Nursing.
To assist NC Private Duty agencies in meeting this
deadline, ACHC is offering a modified accreditation
process to North Carolina agencies who fall under the
guidelines of this new policy.
To expedite the accreditation process, NC Private
Duty agencies are not required to submit a Preliminary
Evidence Report (PER) to ACHC. All agencies are still
required to have all of the policies and procedures
typically included in the PER; however, it is not required
that these be submitted prior to the on-site survey. By
waiving this requirement, an agency is only required
to submit an application (indicating a survey readiness
date) and deposit to begin the accreditation process.
The survey readiness date only provides that an
unannounced, on-site survey will not happen prior to
that date.
For more information on this policy, contact
Mary Kane Ziegler at [email protected]
or (855) 937-2242.