Medicare Compliance & Reimbursement

Here are the hoops nursing homes will have to jump through if CMS heeds new advice.

The regulatory terrain will be getting more treacherous for long-term care hospitals-within-hospitals if the HHS Office of Inspector General gets its way.
 
An Aug. 11 inspection report, "Long Term Care Hospitals-Within-Hospitals" (OEI-01-02-00630), found that 19 of 87 HwHs exceeded the annual 5 percent threshold for readmissions from their host hospitals between 2000 and 2002. Many of these readmissions involved high cost diagnosis-related groups, according to the OIG.
 
"As Medicare's prospective payment system for long-term care hospitals is fully implemented, paying HwHs that are over the 5-percent readmission level could result in increased costs to the Medicare program," the report reads.
     
The Centers for Medicare & Medicaid Services says it is moving forward with programs to address the OIG's concerns. What this could mean for long-term care hospitals:
      Stepped up monitoring of your compliance with the 5 percent readmission rule, and
      new requirements to demonstrate organizational and financial independence from the host hospital.
      The OIG says no such mechanisms are currently in place. To read the report, go to http://www.oig.hhs.gov/oei/reports/oei-01-02-00630.pdf.