Healthcare Matters

   A Complimentary Newsletter From:

Barmak and Associates, LLC  

Managing Risk for Long Term Care and Health Care Providers

Volume 15, Issue 2                      ADVERTISEMENT                            February 2014

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In This Issue
Building a Corporate Culture of Compliance One Gold Star at a Time
New Jersey Health Insurance Coverage Requirements for Full Time vs. Part Time Employees
2014 Fiscal year OIG Work Plan for Nursing Homes
David

David Barmak, Esq.

 

Matthew Streger

Matthew Streger, Esq.

 Of Counsel

Brandon

Brandon Goldberg, Esq.

 

Jennifer Cohen

Jennifer Cohen, Esq.

 

Aaron Rubin

Aaron Rubin, Esq.

 

  

 

Click on Attorney's Picture for More Information 

 

Building a Corporate Culture of Compliance One Gold Star at a Time!
Written by David S. Barmak, JD of Barmak and Associates, LLC in collaboration with Virigina Rosso, RN, MS, Director of QC, White House Rehabilitation Center, Inc. Orange, NJ 

REMEMBER receiving gold stars way back when? I'm a little embarrassed to say that my memories involve more red, silver and blue than gold. Well, for those of you who share my memories, here's our chance to change that.  

 

I'm sure all of us, as professionals in our skilled nursing home industry, would agree that gold stars are routinely earned throughout our facilities:  nursing, social work, admissions, business, human resources, risk management, etc.  If we took the time to actually award gold stars for every "very well done" effort throughout our days in our efforts to improve the quality of life for our residents, no doubt we'd all have an ever-growing library of notebooks filled with gold stars.

 

When the Office of the Inspector General walks in the front door and asks for proof that we have an effective compliance program, we need to assertively but humbly present our libraries of notebooks filled with gold stars. Why? Because a gold star represents far more than success in any particular situation, moment or process.  A gold star represents, ultimately, a good faith effort to do the right thing. When we organize all of the gold stars together, we can see a mosaic of our organization's corporate culture. A mosaic of gold stars clearly presents a corporate culture of good faith efforts to comply with laws and regulations.  We want to present a culture of compliance in order to convey that a mistake is a mistake and to negate any possible inference of criminal intent.

 

Where are our gold stars that are either lost or gathering dust?  Lost to everyone other than those who participated in the momentary process or event that earned the gold star; gathering dust because recognition was bestowed upon the participants but with no further recognition.

- Incidents and Accident reports;

- Quarterly QAPI Committee Reports;

- Reimbursement Consultant reports;

- Audit reports from all departments

 

When the OIG comes in the front door, we want to present our Compliance Program Workplans as evidence of a corporate culture of compliance. To do so, we must gather the most telling and significant gold stars from all departments and processes within our facilities. Perhaps even more importantly, we need to also gather all of the red, blue and silver stars too - to show our objectivity, transparency and honesty.  After all, we are human.  But that's not enough - we must clearly show stubborn, persistent and unrelenting efforts to elevate red, blue and silver stars into gold stars and especially show the results of those efforts, never stopping until we have achieved this alchemy and continually maintaining the gold star.  

 

Now we have our blueprint of a real and effective corporate culture of compliance. 

 

New Jersey Health Insurance Coverage Requirements for Full Time vs. Part Time Employees 
By: Brandon C. Goldberg, Esq. 

With the extensive discussion regarding the impact of Obamacare insurance requirements on the balance between full and part time employees, there have been questions regarding whether for New Jersey purposes, the definition of full versus part time has changed at all.

 

New Jersey's definition of the hours needed to make someone eligible for health coverage has NOT yet changed. It is still 25 hours per week on a regular basis. The federal definition is 30 hours per week on average or a 130 hour month. It appears that the more liberal New Jersey requirement may be changed to match the federal definition in 2016, but that won't be certain for some time. Therefore, New Jersey employers must continue to apply the state standard for defining full and part time employees.

 

It is important to note though that now, independent contractors (1099) individuals are not eligible for Small Group coverage in New Jersey, even if those individuals are above 25 hours. They must now be W-2 employees in order to be eligible.

 

If you have any questions regarding full versus part time employment options or determining whether an individual should be a W-2 or 1099, please contact Brandon Goldberg, Esq. at 609-454-5351 or bgoldberg@barmak.com.


 

2014 Fiscal Year OIG Work Plan for Nursing Homes 

Medicare Part A billing by skilled nursing facilities (new)

Policies and Practices. We will describe SNF billing practices in selected years and will describe variation in billing among SNFs in those years. Context-Prior OIG work found that SNFs increasingly billed for the highest level of therapy even though beneficiary characteristics remained largely unchanged. OIG also found that SNFs billed one-quarter of all 2009 claims in error, resulting in $1.5 billion in inappropriate Medicare payments. CMS has made substantial changes to how SNFs bill for services for Medicare Part A stays. (OEI; 02-13-00610; 00-00-0000; various reviews; expected issue date: FY 2014; work in progress)

 

Questionable billing patterns for Part B services during nursing home stays

Billing and Payments. We will identify questionable billing patterns associated with nursing homes and Medicare providers for Part B services provided to nursing home residents during stays not paid under Part A (for example, stays during which benefits are exhausted or the 3-day prior-inpatient- stay requirement is not met). A series of studies will examine several broad categories of services, such as foot care. Context-Congress explicitly directed OIG to monitor Part B billing for abuse during non-Part A stays. (Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), 313.) (OEI; 06-14-00160; various reviews; expected issue date: FY 2014; work in progress)

 

State agency verification of deficiency corrections

Quality of Care and Safety-We will determine whether State survey agencies verified correction plans for deficiencies identified during nursing home recertification surveys. Context-A prior OIG review found that one State survey agency did not always verify that nursing homes corrected deficiencies identified during surveys in accordance with Federal requirements. Federal regulations require nursing homes to submit correction plans to the State survey agency or CMS for deficiencies identified during surveys. (42 CFR 488.402(d).) CMS requires State survey agencies to verify the correction of identified deficiencies through onsite reviews or by obtaining other evidence of correction. (State Operations Manual, Pub. No. 100-07, 7300.3.) (OAS; W-00-13-35701; W-00-14- 35101; various reviews; expected issue date: FY 2014; work in progress)

 

Program for national background checks for long-term-care employees

Quality of Care and Safety. We will review the procedures implemented by participating States for long-term-care facilities or providers to conduct background checks on prospective employees and providers who would have direct access to patients and determine the costs of conducting background checks. We will determine the outcomes of the States' programs and determine whether the programs led to any unintended consequences. Contex-This mandated work is ongoing and will be issued at the program's conclusion as required. (Affordable Care Act, 6401.) (OEI; 07-10-00420; expected issue date: FY 2017; work in progress; Affordable Care Act)

 

Hospitalizations of nursing home residents for manageable and preventable conditions

Quality of Care and Safety-We will determine the extent to which Medicare beneficiaries residing in nursing homes are hospitalized as a result of conditions thought to be manageable or preventable in the nursing home setting. Context-A 2013 OIG review found that 25 percent of Medicare beneficiaries were hospitalized for any reason in FY 2011. Hospitalizations of nursing home residents are costly to Medicare and may indicate quality-of-care problems in the nursing homes. (OEI; 06-11- 00041; expected issue date: FY 2014; work in progress)

 

 

 

 

 

Barmak and Associates, LLC      

 

Our law firm provides integrated regulatory, transactional, employment and litigation/advocacy services to healthcare organizations.

   

Representative Clients: 

Entities:  Skilled nursing facilities; Home health agencies; Hospice agencies; Hospitals.

 

Providers: Physicians; Therapists; Orthotists and Prosthetists

 

Suppliers:  Durable medical equipment; Long-term care pharmacies; Retail pharmacies.

 

Businesses: Billing; Management service organizations; Independent provider associations

 

Regulatory Issues: Corporate Compliance Programs (Fraud, waste & abuse; Privacy & Data Security; Employment); Healthcare facility; Licensed Professionals; Medicare & Medicaid (certification, survey and reimbursement); Auditing (legal; clinical; administrative; and reimbursement).

 

Transaction Issues: General Counsel Services; Contracts.
          
Employment Issues: Wage and hour; Equal employment opportunity; Discrimination; Whistle-blowing; Employment agreements; Severance packages; Employee release agreements, Non-compete agreements; Non-solicitation agreements; Confidentiality agreements, Employee leave issues, Electronic monitoring and employee privacy, Employee separation (suspensions, terminations and reductions in force); Documentation.

  

Litigation/Advocacy: Contracts; Employment; Fiduciary issues; Commercial leases; Payment (Managed Care Organizations; Medicare; Medicaid); Guardianship; Professional and facility licensing; Healthcare regulatory; Fraud and privacy issues.
  
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This newsletter has been prepared by Barmak and Associates, LLC for informational purposes only and is not intended to provide legal advice. You should consult an attorney for advice regarding your individual situation. We invite you to contact us. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established.

  

For more information, please contact:

David S. Barmak, Esq.

Telephone (609) 454-5351
Fax (609) 454-5361

www.barmak.com

  
  
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