Medicare regs

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does anyone know how you would go about reporting to medicare that a particular agency is not following "the rules"...for example 48hr admission to HH after hospital stay....this agency lets the admissions just pile up and sees them whenever....and just says "patient choice"////sure patients have the right to refuse to be admitted on a particular day but from my experience that is the exception to the rule. just not right!!!!( it is because they don't have the staff to cover the admissions)...the patient is the one that suffers.

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Specializes in Functional Medicine, Holistic Nutrition.

Non-compliance with this regulation could be difficult to prove, depending on how the agency is documenting it. Are they having the schedulers/intake staff document that they contacted the patient for a visit and the patient prefers another day?

The first place that you can make a complaint is to the state agency responsible for the licensing of your agency. In most states, this is called the "Department of Health" or some division thereof that does the licensing. These state agencies assume responsibility for upholding CMS regulations. You can also report to the federal Office of the Inspector General, althought that is typically reserved for cases in which Medicare fraud or abuse is suspected and they usually send the state in to investigate anyway. If your agency is accredited, you can also report to the accrediating agency, such as the Joint Commission or CHAP.

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( it is because they don't have the staff to cover the admissions)...

If they don't have the staff, then who is going to do the admissions? Are you willing to give up all your free time to do them? I ask this in this way, because I just posted a new thread "Anyone else sick and tired of being asked to work every weekend?". I feel the agency managers should deal with the situation by hiring someone for weekends, etc, but they won't..... So if you report them and they don't hire more staff, then be ready to work when you're suppose to be off. However, I'm not saying I think it is right for the patient, it's just the way it is....

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If they don't have the staff, then who is going to do the admissions? Are you willing to give up all your free time to do them? I ask this in this way, because I just posted a new thread "Anyone else sick and tired of being asked to work every weekend?". I feel the agency managers should deal with the situation by hiring someone for weekends, etc, but they won't..... So if you report them and they don't hire more staff, then be ready to work when you're suppose to be off. However, I'm not saying I think it is right for the patient, it's just the way it is....

i agree it is a management problem, they need to do this extra or don't take the referrals!!! the solution is always easy for us to see.

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the solution is always easy for us to see.

Yes, it's VERY easy for me to see many issues at my work and the solutions. However, when I've spoken up regarding the problems and potential solutions I get shot down. I recently spoke my view to my company regarding the tons of paperwork we are required to do on top of using a comprehensive computer program and how this is a waste of time, impacts productivity, etc. and they refused to listen and became defensive........ very frustrating. :uhoh3:

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