Medicare Compliance & Reimbursement

Birmingham nursing home runs into a snag on almost-perfect audit.

Nursing homes that toe the line when it comes to federal and state laws will still get pinched if data submitted to the Nursing Home Compare database is not flush with on-the-floor inspections.
 
A pair of Alabama nursing facilities -- ConsultAmerica Health and Rehabilitation and Luverne Health and Rehabilitation -- sailed through recent audits by the HHS Office of Inspector General. Both were in compliance with federal and state staffing standards, with all direct care employees properly licensed and certified -- and even given background checks, though not required by Alabama law.

However, ConsultAmerica suffered a small setback when auditors noted significant differences between the direct care hours documented on staff schedules and payroll records compared to the hours reported in the Centers for Medicare & Medicaid Services' Nursing Home Compare Web site. The auditors calculated only 3.83 direct care hours -- 27 percent less than Consult- America had reported for the same time period. This puts the facility below the national average of 3.9 direct care hours, as well as the Alabama state average of 4.2 direct care hours, according to the audit.

Luverne's direct care hours were posted on the CMS Web site as 3.66 direct care hours, an "insignificant" .04 difference from the 3.62 calculated by auditors.

To see the audits, titled, "Effect of Staffing on Quality of Care at Nursing Facilities - Luverne Health and Rehabilitation" (A-04-04-04004), and "Effect of Staffing on Quality of Care at Nursing Facilities - ConsultAmerica Health and Rehabilitation" (A-04-04-03028), go to http://oig.hhs.gov/oas/oas/cms.html.   

Lesson Learned: Nursing homes are reminded that the OIG has its eye on their staffing policies.