Billing Practices of Skilled Nursing Facilities Under Scrutiny
by Michael Rosen
This week, the OIG released the results of a study just completed on the billing practices ofskilled nursing facilities to Medicare. The study located a stunning amount of “inaccurate,medically unnecessary, and fraudulent claims.” The main focus of the study was to focus onbilling practices for therapy provided skilled nursing facilities. The study located over a billiondollars in inappropriate billing in 2009 alone. The recommendations of the study included:
Increase and expand reviews of SNF claims,
Use its Fraud Prevention System to identify SNFs that are billing for higher paying RUGs,
Monitor compliance with new therapy assessments,
Change the current method for determining how much therapy is needed to ensure appropriatepayments,
Improve the accuracy of MDS items, and
Follow up on the SNFs that billed in error.
Skilled nursing facilities are certain to come under more scrutiny regarding billing practices forMedicare services. Make certain your organization has procedures in place to prevent codingerrors as well as other prohibitied billing practices including employing individuals listed on theOIG exclusion list.
Know How to Have the Right Family and Job Balance to Have Fulfilling Family Life
We are all living in a fast paced work environment and this makes it very difficult for us tobalance the family and job in the way it has to be done for getting greater degree of harmony andfulfillment. But this is not easy and not everyone in a high demanding career is able to giveenough time to their families. Usually it is the family life that suffers in case of a high payingcareer that takes away the time you have to allot for the family. In the present days the mobilephones and the tablet computers, and the laptops are stealing the time you are spending with yourfamily and are effectively bringing down the quality of time you spend with your spouse and yourkids.
This is not a healthy situation for the present day executives who have to be very efficient andhave to fulfill their awfully demanding job requirements. This makes them unable to devote asmuch time they want to their families straining the relationships, and bringing down the qualityof their family life. But this must be avoided at all costs and maintaining good balance of thefamily and job is necessary for a perfectly happy life. You must not forget the fact that all yourearnings and the hard work you put in your office is for giving a better life to your family and assuch it is the family that must have the priority over your work pressures.
There are many ways of making a good balance of family and job and this must be done rightfrom the day of entering your first job so that it becomes a way of life. Once you forget to do thisit may be very difficult to achieve this later in life. To avoid personal unhappiness and a hollowpersonal life create a clear demarcation of your family and business life. There are many socialand cultural factors that come in the way of creating that balanced family and business life. Yetyou must strive hard to create one and stay with it so that you are able to become a good spouseand father in your home as you become a good worker in your business place.
A perfect balance in family and job can be achieved by adhering to certain basic principles thatgives a better understanding of your priorities and that of each one of your family. This gives theright ways of getting them arranged in the order of importance so that you can easily find theways to achieve them. You can make way for the resources required in terms of your time andpersonal attention so that everyone in your family gets what they value most in a natural way.Plan ahead and make it a habit to have time to be together with all of the family each day. Shareyour thoughts for the day and this will really boost the way to enhance the feeling of togethernessin the family.
Taking part in your kid’s activities and devoting a part of your time towards this will give a betteropportunity to understand your kids well. Planning ahead and setting apart time for this is sure tomake your time at your office more efficient as you try to leave your office in time to be withyour kids you will be able to find the right balance for your family and job. Leave work at yourwork and be free at least for some time without your ringing mobile phone or that laptop waitingfor your attention when you are spending your time with your family. Thus do not sacrifice yourfamily life for your business life and always try to have that perfect family and job balance tohave a fulfilling life.
Have you every been a resident in your own building?
By Ken Tack
Here I am in my 40th year of long-term care. That is an eternity when you spend it in a field thathas had so many changes. Earlier this year, I was looking forward to a comfortable time, havingrecently stepped down from the CEO position of a regional group of homes that I had helped tofound many years ago. The next generation was doing a good job of running the company, and Iwas hidden away in one of the campuses as an executive director. I was back doing what I loved:running a nursing home, and interacting with the elders.
On April 15, my world changed. I was involved in a motorcycle collision. I was flown to aregional hospital. After surgery and some observation, I volunteered to transfer to one of ourcompany’s nursing homes, where I was for a month. I had never dreamed of being a resident in anursing home, at least at this age, but here I was. With little to do but observe, I had the greatest educational experience of my career. I saw withmy eyes, heard with my ears, and felt with my heart the low level of compassion the care staffwas experiencing. All the hopes and dreams of making life better that filled them when they firststarted had been slowly sucked from them. They were running on empty and I was very much apart of the problem.
Before I proceed further, let me publicly profess that I am deeply grieved by the callous manner Ihave treated the caregivers in our organization. Although I have never knowingly hurt any staffmember, I have been neglectful of many as an individual and as a person. All my training and thevolumes of regulations have helped to create this inappropriate conduct. With one eye on thebottom line and the other on the regulating bodies, I never saw what was occurring in front of mynose.
Our people, the backbone of each organization, our caregivers, are hurting. The stress of holdingto tightly tailored PPD numbers, conflicts with co-workers, family members, and the occasionalspouse, coupled with a career that forces you to have relationships that end in death, can suck theair from anyone’s compassion balloon. When you mix in the stress of being a parent, spouse,family financier, chauffeur, and referee, you can end up with a person who is bankrupt ofcompassion.
The thing that is most disturbing to me is how we have accepted this in the profession as “Justthe way things are.” We say that this attitude on everyone’s part is simply a part of our business —it’s nothing personal. But I believe it does not have to be this way. When we open our eyes to thispractice of devouring our own limited resources we begin to see it. What happens when acaregiver begins to lose their compassion and then their performance slips? Our traditionalresponse is to have a discussion with them about their performance, reminding them howimportant they are to our elder’s lives. When that doesn’t correct the problem, and it rarely does,we give them a second, sterner warning (a written warning in many cases). Finally, exasperatedwith their poor showing, we are forced to terminate them only to begin the process over and hopewe achieve a better result.
We see this every day when we see employees hiding in a room, having attendance problems,leaving an elder in a mess, talking over the elders’ head, and taking too frequent breaks. We labelthem a bad employee and place them on the “do not rehire” list when they resign, or we terminatethem. Did we ever see this caregiver, once filled with hopes and dreams of what they might dofor these aging individuals, as a person in need of a compassion refilling? For the first time I wasable to see employees in this new light.
When we have epiphanies like these we may ask, ‘What can we do about it?’ The answer is wecan begin by caring and letting employees know that we do that we care about them. We canspend as much time preventing the problem of compassion bankruptcy, as we do in fixing theresults. We still try to find good applicants, interview them, process them, train them and directthem. But we also can look them in the eye everyday and see the person that is there. We can askthem how things are doing and actually take the time to hear what they have to say. When theyhave a problem, whether it is work-related or not, we can make an effort to give them the supportand caring we ask that they give our elders.
Here are some suggestions of various ways we have attempted to support and care about ourmost precious asset:
Nourishment station in the staff lounge. We offer various fruits, crackers, bagels, ice cream,Popsicles, etc.Wider variety of scheduling options to permit an improved mesh of personal life with workA monthly dish day where we provide the main course and the caregivers bring their favorite sidedish or desert. (The kitchen staff does not prepare the main course: remember they are a part ofthe caregiver team.)Surprise gifts, including door prizes and other giveaways at in-house in-servicesAdministration and department supervisors are encouraged to take an employee out to eat, alongwith a caregiver’s family member. We cover the meals and the time it takes them for a leisurelyvisit.We send birthday cards to the caregiver’s house.Training supervisors to look for signs of compassion fatigue and then supporting them as theyassist their staff.The most important thing we have tried to do is let each care partner know that we truly careabout him or her. We are attempting to celebrate their joys and support employees in theirsorrows, praise them for what we had just taken for granted, and understand when they arestruggling. It’s not our goal to be their closest friend, but we can be a support and inflate theirballoon of compassion when it starts to shrink.
Forty years of doing something wrong can make change a little difficult, but this is now theearliest I can begin to make the change. I have begun making rounds with an entirely differentobjective.
As one who contributed far more than my share to the draining of this compassion, I have done a180-degree turn. If I am to ever be remembered by the long-term care industry, I pray that it willbe for helping to put compassion back in our caregivers, not the financially successful company Ihave helped to build.
