Staying on the right side of compliance

Elizabeth Newman
Elizabeth Newman

In the 403-page Centers for Medicare & Medicaid Services proposed rule, there has been a lot of discussion around arbitration, quality and education. But buried within also are new regulations around compliance programs.

Since the Affordable Care Act required skilled nursing facilities to have a compliance program in place by March 2013, many providers think they're fine. But compliance is an area where administrators tend to say, “Here's our code of conduct, here are our regulations listed, peace out.” The new rule means surveyors will now be looking at effective compliance programs and charting the appropriate F-Tag violation, according to attorney Paula G. Saunders, principal in healthcare practice at Post and Schell in Pennsylvania, and Janine Valdez, vice president of compliance at Genesis HealthCare Inc. This will start a year after the final rule goes into effect.

Have they got your attention yet?

Let's start with the basics, which is organizations with five or more SNFs need a designated compliance officer, presumably one in the corporate office. This compliance officer needs industry knowledge, communication skills and the ability to be objective. Additionally there will be a “compliance liaison” at each building who reports to the operating body — this will often be the nursing home administrator.

Next, Sanders and Valdez explained how there must be mandatory compliance training not just for full-time staff, but volunteers and contractual employees, such as the medical director.

This could mean “face-to-face training time,” or a learning management system, Valdez said. Either way, “we are talking about a documented process,” where you have records you can give the surveyor that says everyone has been through compliance training.

There needs to be an annual reassessment of the program, which may mean each administrator filling out a questionnaire with the chief compliance officer discussing where posters are hung, confirmation of triple-check, or any other compliance questions.

Where lawyers such as Sanders become concerned is around periodic external audits and meeting surveyor standards.

“How do we do evidence-based proof?” Sanders posed. “The Code of Conduct should be easy — own it now, personalize it. But while a lot of people have a code of conduct, they do not have policies and procedures around compliance.”

More objective is catching employees excluded from participating in Medicare or Medicaid — in addition to the OIG exclusion list, facilities also need to check state databases. Some states require checking once a month.

“The government is looking for people,” Valdez warned.

It ultimately comes down to being proactive, Sanders said, and documenting when there's a problem.

“You need a documented process for correction. The corrective action may be repayment or training. Have enforcement disciplinary measures,” Valdez warned. “If someone violated the code, you need something that shows your standards.”

Elizabeth Leis Newman is Senior Editor at McKnight's. Follow her @TigerELN.

Elizabeth's Etiquette Tip: Social media is still a new frontier, and unfortunately can bring out the worst in people. Three easy tips: First, around 80% of your organization's feed should be discussing or promoting someone or something else, while 20% can be “We're awesome.” Two, remind employees the same harassment policies apply to interactions online. Three, don't pitch your products to another organization or media outlet through social media — it's not going to get you anywhere, and comes across as tacky. Send an email instead.


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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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