Although a new software system or a form may be put in place in our respective agencies, they are only tools. Tracking software could prove to an FBI agent that you did make a visit and the fraud in the agency lies with the sweet little biller in the finance office. Thatís where we are in home health these days because of fraud. I'm in a high-fraud area and many of my posts run along that vein. After reading many entries in this forum, Iíve wondered (I hope erroneously) if my fellow nurses know whatís happening in our industry and how we are impacted. Depending on the management team to inform staff might be laughable in some cases. Medicare fraud is big, RACS and P4P are here and AS MANAGERS WE NEED TO INFORM STAFF of their roles in all of this. Too often people are told what to do without a reason why. Grown people want to know why.
The office QA person should be there for you and Iím sorry not an LPN. QA needs to be all over these sites so they can interpret to staff what is needed.
To expand your knowledge on what YOU NEED to know, Google some of the following terms: home health compare, home health fraud, pay for performance in home health care, etc.
Pay for performance (P4P) is why you need to complete the OASIS to best of your ability. So yes, we all need to do it better. The link below explains in a nutshell home health agencies being paid incentives for good outcomes. The Home Health Compare compares SOC OASIS to D/C OASIS. The public is advised to look at this site to see how well an agency provides care for its patients. Are you willing to do it better so your agency is chosen over another? Centers for Medicare Medicaid Services
then search home health-all you ever need to know is here Medicares Home Health Pay for Performance Demonstration Year 1 Incentive Payments Issued Medicare.gov ‚Äď the Official U.S. Government Site for Medicare
OASIS Answers, Inc.
The fraud in home care is ridiculous. Seven cities are being targeted by the feds. There are things some of you may be doing and not realize itís fraudulent. Are you making corrections the right way or should you touch that documentation at all?!?!? Your management team may not know either. Public service announcements are running on TV and radio stations to inform the public to say no to people offering gift cards, house cleaning, etc. Stop Medicare Fraud
Recovery Audit Contractors (RACS) These guys have mining software (tracking the agency) that arbitrarily pulls records for review is you bill m-caid or m-care. These guys are to identify and recover overpayments made by Medicare Advantage plans, Part D and Medicaid. Agencies must self-report and return the overpayment in 60 days. Now if there is charting that does not support the plan of care, they will say you didnít do what you were paid to do. US gov takes the money back. Of course the RACs get a percentage of what they recover so you know how fine-toothed their combs are. What if they want money back on 20 cases? That amount could equate to hundreds of thousands of dollars and close an agency immediately. Private insurance companies have always done this. Overview Recovery Audit Contractor
Take care of yourself by informing yourself. Ruby and Dijmart tracking sucks but never do you want an unscrupulous manager blaming you for visits not made to cover themselves for what they aren't doing. I've seen it happen. When I've talked to nurses and other clinicians who have sat with FBI agents, they were happy to have proof they were in the home.