OIG on RAC Fraud Referrals

This was a report received thru the OIG Public Affairs.

Recovery Audit Contractors' Fraud Referrals (OEI-03-09-00130)

We found that between March 2005 and March 2008, recovery audit contractors (RAC) referred two cases of potential fraud to the Centers for Medicare & Medicaid Services (CMS). However, CMS reported that it received no potential fraud referrals from RACs during this period.

Care Plan Oversight

As I mentioned last month, Senator Collins (R-ME) and Senator Conrad (D-ND) introduced senate bill 2814 on November 20, 2009. This bill would allow for advance practice providers other than physician to order and monitor home care services for patients. Despite several State laws that already allow this, it is not allowed by the Federal Government so it is prohibited under federal reimbursed payment systems such as Medicare and Medicaid.

At the time I last blogged about this issue, it was not clear if this would allow for Advance Practice Providers to bill for care plan oversight. I did receive a letter from Senator Conrad stating that it would not allow for this provision. This is a shame. The Senate needs pressure from its home health constituents to pass this senate bill and add a provision for care plan oversight. I would take the bill as is but if Advance Practice Providers like Nurse Practioners are doing the equability work of a physician they should be reimbursed for that.

This bill still remains in the Senate Finance Committee for review. I would be interested in your feedback.

Guest Post: Skin Changes at Life's End

Skin Changes At Life’s End

Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-mail: ElizabethHogue@ElizabethHogue.net

In April of 2008, wound care experts met for a round table discussion of the occurrence of Skin Changes At Life’s End (SCALE). The condition of a patient’s skin can provide a great deal of insight into his/her internal health. Illnesses that usually worsen and result in death are frequently accompanied by pressure ulcers. SCALE, therefore, is a term for the compromise of the skin organ during the end stages of life.

As a result of their discussion of this phenomenon, and subsequent input from experts in wound care and palliative medicine, on October 1, 2009 the SCALE Expert Panel published the following ten consensus statements:

Month one of OASIS-C

Irrational rational

Illogic logic

Just a plain, what were they thinking?

I’m a big fan of the OASIS assessment because of the practical, efficient applications that result from the data collected; PPS calculation, quality measures and a standardized tool that every agency has to use. It intrigued me to learn the relationships of the specific questions and the complex calculations which either resulted in payment calculations or risk adjusted outcomes.

Learning these relationships over the years, we have learned small but critical improvements that were needed. M0700 ambulation/locomotion needed to be more specific in order to show the improvement a patient makes from using a walker to a single hand cane. Certain questions that were nonspecific and difficult to answer were eliminated, like M0280 Life Expectancy - likely hood a patient was going to live more than 6 months. For these details and other evidence based practices learned over the decade OASIS-C was created.