Although there haven’t been any updates in the 2015 Work Plan pertaining to Nursing Homes and Hospices, there have been a couple of new areas of focus relating to Hospitals, which you should be aware of.
The first update is regarding hospital wage data reporting, which is used to calculate Medicaid payments. The 2015 Work Plan said that previous erroneous wage data reporting amounted to hundreds of millions of dollars, consequently prompting their policy change regarding how hospitals account deferred compensation costs to the Centers for Medicare & Medicaid Services.
Secondly, for beneficiaries of Medicare who are being cared for in long-term care hospitals (LTCHs), the OIG added to the Work Plan both adverse and temporary harm events in post-acute care. According to the Work Plan, LTCHs are among the top three most common types of facilities for post-acute care, and as a result, they account for about 11% of post-acute care Medicare costs.
Adding adverse and temporary-harm events that occur in LTCHs to the new Work Plan (which presently does provide for the monitoring of these events at in-patient rehab facilities) is in accordance with the increased focus on long-term care facilities in recent years. CMS, OIG, local and regional regulators have worked hard to discover and root out fraud, increase quality, and rein in costs at these particular providers, which take care of some of the most medically complex and costly program beneficiaries.
In addition to the aforementioned updates relating to hospitals, this year, the OIG will also be conducting a review of the expenditures that states have claimed under the Balancing Incentive Program (BIP), a program that was established to provide matching funds from the federal government for certain eligible expenditures for long-term services.
You can find the complete 2015 Work Plan by clicking here.