Corporate Compliance

Is your facility doing everything that it can to be compliant? With all of the updates in one place below, you can stay up to date on OIG guidance and the requirements of the Affordable Care Act standards. Also, learn about the most effective prevention tactics to protect your facility from non-compliance so that you can focus on what’s most important - caring for your residents.

  • OIG to look at PBJ: CMS Oversight of Nursing Facility Staffing Levels (8/18)

    By OIG - August 22, 2018
    Staffing levels in nursing facilities can impact residents' quality of care. Nursing facilities that receive Medicaid and Medicare payments must provide sufficient licensed nursing services 24 hours a day, including a registered nurse for at least 8 consecutive hours every day. CMS uses auditable daily staffing data, called the Payroll-Based Journal, to analyze staffing patterns and populate the staffing component of the Nursing Home Compare website - a site that enables the public to compare the results of health and safety inspections, the quality of care provided at nursing facilities, and staffing at nursing facilities. We will examine nursing staffing levels reported by facilities to the Payroll-Based Journal and CMS's efforts to ensure data accuracy and improve resident quality of care by both enforcing minimum requirements and incentivizing high quality staffing above minimum requirements.
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  • LTCSP Initial Pool Care Areas UPDATED (8/18)

    By CMS - August 06, 2018
    This includes four documents, one each for: record review, resident interview, resident observations, and resident representative interview. They walk through what the surveyors investigate/ask related to each care area during the initial pool to help determine which residents they will choose for in-depth investigations in the final sample. In other words, these screening tools trigger surveyors to either investigate further or not investigate further.
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  • LTCSP Survey Resources Including Entrance Conference Worksheet and Beneficiary Protection Notification Review Worksheet UPDATED (8/18)

    By CMS - August 06, 2018
    This Long-term Care Survey Process ZIP file contains a multitude of reference materials that are provided to the surveyors going into facilities, including, for example, a document detailing their principles of documentation, a document showing how they edit and finalize statements of deficient practices, and a tool breaking out resident interview questions in the initial pool process by care areas, such as choices, activities, abuse, etc. In addition, this file is now the only resource containing the Entrance Conference Worksheet and the Beneficiary Protection Notification Review Worksheet.

    NOTE: CMS updated this file on Aug. 3,  2018.

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  • LTCSP Procedure Guide and Training - Updated (7/18)

    By CMS - July 26, 2018

    The LTCSP Procedure Guide provides instruction on the procedural and software steps necessary for completing the Long-term Care Survey Process. Surveyors use the Procedure Guide for all standard surveys of SNFs and NFs, whether freestanding, distinct parts, or dually participating. The LTCSP steps are organized into seven parts: 1) offsite preparation; 2) facility entrance; 3) initial pool process; 4) sample selection; 5) investigation; 6) ongoing and other survey activities; and 7) potential citations. Below is a broad overview of the key onsite parts of the LTCSP (parts 3 – 7).

     
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  • Nursing Home Compare & PBJ Updates: Long-stay Resident Hospitalization Rate to Be Added to NHC / Five Star; Non-Nursing Staff for PBJ to Be Posted; Health Inspection Freeze to End (6/18)

    By CMS - June 22, 2018
    • In October 2018, the long-stay hospitalization measure will be posted on the Nursing Home Compare website as a long-stay quality measure. In the spring of 2019, this quality measure will be included in the Five Star Quality Rating System.  Additionally, in July 2018 we will update the other claims-based quality measures reported on the Nursing Home Compare website.
    • To increase transparency, CMS will begin posting the number of hours worked by other staff (i.e., non-nursing) in July 2018. Facilities are required to submit hours for all other staff as listed in Table 1 of the PBJ Policy Manual. We will also distinguish between hours submitted for direct employees and contract staff. 
    • In October 2019, CMS will resume posting the average number of citations per inspection for each state and nationally. CMS is monitoring outcomes of the new inspection process and plans to resume health inspection rating calculations (i.e., end the freeze) in the spring of 2019. CMS will communicate more details about this prior to its implementation.



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  • RAC Approved and Proposed Topic Lists (6/18)

    By CMS - June 11, 2018
    CMS now maintains pages listing approved and proposed RAC topics for the Recovery Audit program.
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  • CMS Basic Life Safety Online Training Course Available (4.18)

    By CMS - April 24, 2018

    New CMS eLearning course: The BLSC Training Online Course is intended to cultivate and refine surveyor skills, foster understanding of the survey process, and enhance surveyors’ overall ability to conduct LSC surveys for Medicare and Medicaid certification on behalf of CMS.

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  • PBJ Public Use Files: 3Q 17 Data Available (4/18)

    By CMS - April 23, 2018
    CMS releases quarterly Payroll-Based Journal (PBJ) public-use files that currently include nursing hours and resident census data for every nursing home in the United States. 
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  • PBJ Data Used in 5 Star Effective April 2018; CMS-671 Collection Ends June 1 (4/18)

    By CMS - April 09, 2018

    • Transition to Payroll-Based Journal (PBJ) Data – Starting in April, 2018, CMS will use PBJ data to determine each facility’s staffing measure on the Nursing Home Compare tool on Medicare.gov website, and calculate the staffing rating used in the Nursing Home Five Star Quality Rating System.

    • Staffing data audits - We are providing lessons-learned from audits conducted, and guidance to facilities for improving their accuracy. Nursing homes whose audit identifies significant inaccuracies between the hours reported and the hours verified, or facilities who fail to submit any data by the required deadline will be presumed to have low levels of staff. This will result in a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter.

    • Requirement for registered nurse (RN) staffing – We are reminding nursing homes of the importance of RN staffing and the requirement to have an RN onsite 8 hours a day, 7 days a week. Nursing homes reporting 7 or more days in a quarter with no RN hours will receive a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter. This action will be implemented in July 2018, after the May 15, 2018 submission deadline for data for 2018 Calendar Quarter 1, 2018 (January – March, 2018) data.

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  • CMS Updates Revised SNF ABN Medicare Claims Processing Manual Guidance, Moves up Mandatory Implementation (3/18)

    By CMS - March 30, 2018
    The purpose of this change request (CR) is to revise the SNF ABN, Form CMS-10055. With this revision, CMS is discontinuing the 5 SNF Denial Letters and the Notice of Exclusion from Medicare Benefits (NEMB-SNF), Form CMS-20014.
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  • LTCSP: CMS Training Videos Walk Through Survey Process (3/18)

    By CMS - March 30, 2018
    These videos are part of a training series created for surveyors of long term care facilities. They are designed to augment live training sessions and to be used as substitutes for surveyors that could not attend the in-person sessions.
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  • Revised SNF ABN (Form CMS-10055) Is Mandatory Effective May 7, 2018

    By CMS - February 01, 2018

    CMS has released a newly revised SNFABN along with newly developed, concise and separate instructions for form completion. The revised SNFABN has the requirements from the denial letters and looks very similar to the ABN with 3 different options. 

    CMS will be discontinuing the 5 SNF Denial Letters and the Notice of Exclusion from Medicare Benefits - Skilled Nursing Facility (NEMB-SNF).  Since the NEMB-SNF was used as a voluntary notice for care that is never covered by Medicare, CMS will continue to encourage SNFs to issue the revised SNFABN in this voluntary capacity.  Chapter 30, Section 70 of the Medicare Claims Processing Manual revisions will be forthcoming. 

    The revised SNFABN will be mandatory for use on May 7, 2018.  

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  • Q&A: Our facility primarily uses electronic health records. Are there any items that require the original hard copy to be retained or can all items be shredded once scanned?

    By Judi Kulus, RAC-MT,DNS-CT,MAT,RN,NHA - January 24, 2018
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  • OIG to Review Potential Abuse and Neglect of Medicare Beneficiaries (1/18)

    By OIG - January 22, 2018

    Medicare beneficiaries, including elders and disabled persons, are being treated at inpatient and outpatient medical facilities for conditions that may be the result of abuse or neglect. The Elder Justice Act recognizes an older person's rights, including the right to be free of abuse, neglect, and exploitation. In addition, all 50 States have mandated reporter laws for the reporting of the potential abuse or neglect of elders and vulnerable persons. Prior OIG reviews have shown that there are problems with the quality of care and the reporting and investigation of potential abuse or neglect at group homes, nursing homes, and skilled nursing facilities. By analyzing the treating medical facilities' diagnoses, we will determine the prevalence of the potential abuse or neglect of Medicare beneficiaries. We will also determine whether the potential abuse or neglect occurred at a medical facility or at another location, such as the Medicare beneficiary's home.

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  • Revised Federal Oversight Support Survey (FOSS) Process National Pilot (1/18)

    By CMS - January 02, 2018

    Memo # 18-06-NH

    Posting Date

    2017-12-26

    Fiscal Year 2018

    Summary

    The Centers for Medicare & Medicaid Services (CMS) will be piloting a two phase Federal Oversight Support Survey (FOSS) process beginning in January of 2018. This pilot will replace the FOSS process used for traditional surveys and the Federal Oversight of Quality Indicator Survey (FOQIS) process used for Quality Indicator Survey (QIS), and includes the following:

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