The U.S. Department of Health & Human Services Office of the Inspector General has released its 2012 Work Plan with brief descriptions of its eight goals regarding oversight of and quality control for nursing homes, including three new topics for review regarding compliance, post-acute care quality, and billing patterns.
Here are the eight topics the OIG plans to tackle:
- Medicare Requirements for Quality of Care in Skilled Nursing Facilities
- Safety and Quality of Post-Acute Care for Medicare Beneficiaries (New)
- Nursing Home Compliance Plans (New)
- Oversight of Poorly Performing Nursing Homes
- Nursing Home Emergency Preparedness and Evacuations During Selected Natural Disasters
- Medicare Part A Payments to Skilled Nursing Facilities
- Hospitalizations and Rehospitalizations of Nursing Home Residents
- Questionable Billing Patterns During Non-Part A Nursing Home Stays (New)
The new objectives include reviewing the quality of care and safety of Medicare beneficiaries once they’re transferred from acute settings into post-acute care settings including skilled nursing facilities, by evaluating the transfer process along with identifying rates of preventable rehospitalizations from SNFs.
Additionally, the OIG plans to review Medicare- and Medicaid-certified nursing homes’ implementations of compliance plans in their day-to-day operations, and whether or not those plans contain elements detailed in OIG’s compliance program guidance.
And in an attempt to prevent fraudulent Medicare billing, the office will identify “questionable” billing patterns associated with nursing homes and other Medicare providers for ‘Part B’ services provided to nursing home residents whose stays don’t fall under Medicare’s Part A SNF benefit.
Category: Government Programs, Medicare and Medicaid, Senior Care, Senior Housing, Skilled Nursing