2016-2017 SNF Rates Published -- Payout Increases Over $148 Million

Final 2016-2017 SNF rates were published on the AB1629 website on January 9, 2017. In total, this year's global rate cap increase of 3.62 percent, plus add-ons, results in an additional $148 million dollars for SNFs.

Based on the January 9, 2017 publication date, the SNF rates will be uploaded to the Medi-Cal provider master file within 30-60 days. Once loaded to the provider master file, members should begin receiving payment based on the final 2016-2017 rates.

At that time, an erroneous paid claims (EPC) notice will be created to adjust all claims to agree with the final published rates. The EPC process will take approximately six to nine months to complete and will re-adjudicate claims from the beginning of the rate year (August 1, 2016) to the date the rates are loaded into the provider master file.

Read more at: 

http://newsmanager.commpartners.com/cahfeu/issues/2017-01-12/index.html

Posted on January 30, 2017 .

Skilled Nursing Operator to pay $170,000 for Falsifying Records

Autumn Health Care of Zanesville and its owner, Steven Hitchens, both pleaded guilty to multiple charges in October following an investigation that revealed that the organization, including Hitchens and a number of facility managers had altered, forged, and, in some cases, destroyed records in order to maintain Medicare and Medicaid funding.

Among the charges against Hitchens and Autumn Health Care are: 

  • providing unnecessary skilled therapy to Medicaid residents and billing Medicare Part B to pay for these unnecessary medical services; 

  • falsely reporting unnecessary medical services in order to receive a higher reimbursement rate from the Ohio Department of Medicaid; 

  • systematically falsifying resident records to defraud the Ohio Department of Health in an effort to make it appear that missed medical treatments were actually provided;

  • destroying a record outlining an incident involving an ill resident who was found in a snow bank after escaping the facility and forging a new record that falsely described the incident in order to avoid a citation from the Ohio Department of Health. 

  • forging a registered nurse's signature on resident assessments that were electronically sent to the Ohio Department of Health to bypass a requirement that a registered nurse certify the accuracy of the assessment.

The organization will be required to repay more than $52,000 to the Ohio Department of Medicaid, and an additional $40,000 in investigative costs to Attorney General Mike DeWine’s Office. Hitchens was ordered to serve three years of community control, 100 hours of community service, and is now under a period of federal exclusion from the Medicare and Medicaid programs as a result of his conviction.

Additionally, several of the organization’s managers and employees were all also sentenced to community controls and are under a period of federal exclusion from the Medicare and Medicaid programs. As a result, to their convictions, the Ohio State Board of Nursing permanently revoked the nursing licenses of all the nurses convicted of felonies.

For more information regarding this case visit: http://www.mcknights.com/news/provider-to-pay-nearly-170000-for-falsifying-destroying-records/article/630792/?DCMP=EMC-MCK_Weekly&spMailingID=16320456&spUserID=MTM0NDIzMDk1MDgwS0&spJobID=940972772&spReportId=OTQwOTcyNzcyS0

Posted on January 19, 2017 .

EHR Incentive Programs: New Attestation Resources

The Electronic Health Record (EHR) Incentive Programs attestation system is open through February 28. Providers must attest by the deadline to avoid a 2018 payment adjustment. CMS released two attestation worksheets for eligible professionals and eligible hospitals and critical access hospitals. Visit the 2016 Program Requirements webpage for more information.

Posted on January 5, 2017 .

Preparing Long-Term Care Providers for 2017

Compliagent has teamed up with Healthicity to bring you an informative webinar entitled "Preparing Long-Term Care Providers for 2017".  This webinar covers recent enforcement data, a regulatory overview, enforcement case studies and best practice recommendations. Presented by Compliagent's COO, Paige Pennington, this webinar is a helpful resource for all Long Term Care providers looking to stay compliant in 2017. 

SAMHSA Reporting Requirements to Reduce Risk of Diversion for Controlled Medications

With an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin,[1] medication-assisted treatment (MAT) is at the vanguard of America’s fight back against increasingly pervasive opioid and opiate misuse