Are You Getting the Long-Term Care Training You Need?

Long-term care training is crucial now more than ever before. With the OIG and CMS zeroing in on long-term care facilities, you and your staff need to take extra care in getting the training that can mean avoiding fraud, abuse and Stark law problems.

Long-term care training — specifically in how to prepare for an OIG or CMS compliance audit — should be your top priority right now. CMS and the OIG are getting generous funding to enhance their Medicare and Medicaid enforcement efforts, with a main focus on long-term care facilities.

Watch Your Quality of Care, Medication Policies Among the most common long-term care targets are quality-of-care issues, deals with medical directors and suppliers, and medication policies. The OIG and CMS are directing a critical eye toward Stark law violations in long-term care settings.

Your long-term care training should focus on these issues, plus the crucial step of creating and properly using a compliance committee. Of special concern for federal investigators is any deals or contracts you might have with medical directors, doctors and suppliers.

You’ll need make aggressive efforts to unwind or modify these problematic deals — before they send up red flags. What FY 2010 Has in Store for SNF PPS Your long-term care training should also encompass coding, billing and related compliance issues.

Medicare’s final rule on the Prospective Payment System (PPS) for Skilled Nursing Facilities (SNFs) has a plethora of changes in store for your coding and billing.

When planning your long-term care training on these coding, billing and compliance issues, keep in mind these major changes to the SNF PPS:

The RUG IV system will replace the current RUG III system;

FY 2010 payment rates will include a 2.1-percent market basket increase, but the adjustments will result in a negative rate update worth hundreds of millions of dollars;

MDS 3.0 will be implemented; and The ADL scoring range will change to 0 to 16 instead of 4 to 18.

Incorporate these major issues with your fraud, abuse and Stark law education in your long-term care training to keep your facility out of trouble and running smoothly.