The use of electronic health records (EHR) is a growing trend in long-term care today. Acute care settings have led the way in replacing paper records, resulting in improved quality and efficiency, as well as lower costs. As long-term care facilities are following their lead, they should not allow these potential benefits to overshadow the increasingly challenging necessity to secure and protect resident health information.
Q: What should we do if we feel that the auditor’s findings are blatantly wrong?
A: If it is felt the auditor was blatantly wrong, providers should contact the agency immediately to discuss it. For instance, if there was a prescription, but it wasn’t in the file that the auditor had, then it would not be considered an error on the auditor’s part, and the facility should follow the appropriate appeals process. But if the auditor made a mistake, he or she should correct it accordingly before proceeding with an overpayment. If the auditor won’t fix the error, then ask to speak with his or her superior about the issue. Providers have the right to accurate decision-making when it comes to claims processing, medical review, and audits.
On Friday, April 27, 2018, the Centers for Medicare & Medicaid Services (CMS) published a highly anticipated proposed rule containing a recommendation to replace the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV). The proposed model, Patient-Driven Payment Model (PDPM), significantly revises the Resident Classification System, Version I (RCS-I), which was introduced as a potential RUG-IV replacement last April in an Advanced Notice of Proposed Rulemaking.
What do Morningside Ministries, Genesis Healthcare, Signature Healthcare, HCR ManorCare, and Syverson Health and Rehab have in common? A terminal relationship with Medicaid. While Genesis isn’t dead yet, it is fundamentally on life support with a stock price of $1.50 per share and a Medicaid payer mix averaging 73%. HCR ManorCare is in bankruptcy. Morningside Ministries closed its Chandler Estate facility in San Antonio as it simply could not survive on Texas Medicaid payments. Syverson in Wisconsin is among a slowly growing list of skilled nursing facilities (SNF) that cannot financially exist under Wisconsin’s Medicaid system—the poorest payer in relation to cost in the nation.