HANDBOOK

Description

In the skilled nursing facility adhering to the laws and regulations that govern the provision of rehabilitation services is the highest priority. The facility success depends on the Director’s ability to monitor compliance with applicable Federal and State laws with a focus on preventing waste and abuse.

This program is designed to prepare each team member with the necessary tools to address all aspects of the ever-changing Federal, State and local rules and guidelines. The speaker will discuss billing, supervision, patient rights and specific policy and procedures that impact the rehabilitation department within the nursing home setting.  Compliance Programs are intended to assist nursing facilities to develop and implement internal controls and procedures that promote adherence to applicable statutes and regulations of the Federal health care programs and private insurance.

The federal regulation specifically relating to specialized rehabilitation services (483.45) defines specialized rehabilitative services to include, but not be limited to, physical therapy, speech/language therapy, occupational therapy, and mental health rehabilitative services for residents with mental illness and mental retardation.  The federal rule holds that if such specialized rehabilitative services are required in the resident’s comprehensive plan of care, the facility must provide the services or obtain them from an outside provider.  The majority of the conclusions drawn about requirements for rehabilitative services are derived from the Quality Care Regulation (483.25), which states that a resident must receive “the necessary care and services to attain or maintain the highest, practicable physical, mental, and psycho-social well-being.”

This course will also summarize guidelines for rehabilitation services per the State Operations Manual. Regulatory survey within the nursing home is morphing as the government institutes new expectations and guidance. The rehabilitation department must be governed to encompass all changes to remain deficiency free during state surveys.

Why Should You Attend:

Compliance – how is this defined within the walls of your organization? The dictionary uses observance, conformity and obedience to describe compliance. Each healthcare entity is bound by law to develop and adhere to an effective compliance program. Yet, is this directive observed effectively within the rehabilitation department? The unique position of this department, which must carry its own manuals, policies and procedures is subject to much scrutiny by the government. There are many resources available to enhance adherence to the Federal guidelines to aid health care practitioners in understanding the laws regarding fraud and abuse along with the consequences of violating said laws.  With so many regulations pertaining to the provision of rehabilitation services in skilled nursing, ensuring compliance can be daunting.  Adherence to regulations is complicated, entailing training, analysis of data and constant awareness.

This course is designed to help skilled nursing facility leaders in navigating the regulatory demands of this setting. The ability of the team to be effective in managing regulatory change requires comprehension and departmental wide education followed up by consistency in enforcement of policies. The rehabilitation department must conduct Operations in compliance with all federal and state laws, most importantly laws governing the health care setting. Any caregivers assigned to patient care in the rehabilitation department are obligated to perform in an ethical manner per regulatory guidelines put forth by the Office of Inspector General (OIG). This department’s Compliance Program is purposed with minimizing and eliminating fraud and abuse. The facility environment should be one of safety for both the resident as well as the clinician. Proactive identification of risk and correction of potential issues surrounding fraud and abuse begins with exploration of the compliance processes. Many, many times practitioners are misinformed or make faulty assumptions placing the resident or facility at risk for improper treatment planning or billing be-it too much or not enough skilled intervention to address functional performance deficits. Employees are expected to make informed commitments to ethical and legal standards encompassing patient care, confidentiality, billing procedures, and other aspects of treatment relationships. Review of the written policies, updating manuals and guidance within the department hinges on maintaining awareness of the governmental regulations and updates.

Since the Health Insurance Portability and Accountability Act was passed in 1996, adherence to HIPAA regulations has been a point of emphasis across health care, including skilled nursing. The rule, which established national standards to protect individuals’ medical records and other personal health information (PHI), requires in-depth knowledge of what is classified as PHI and who the law pertains to.

This course will highlight operational elements, essentials of documentation in addition to reimbursement/regulatory changes influencing departmental compliance.

Learning Objectives:

  • Attendees will be able to state three strategies for measuring compliance program effectiveness.
  • The learner will be able to identify operational elements of the Rehabilitation Department and how to avoid risk.
  • The learner will be able to state three essentials of Skilled Documentation to maintain compliance.
  • The learner will state reimbursement/regulatory changes influencing departmental compliance.
  • The attendees will identify state specific interpretive guidelines related to rehabilitative space and equipment.

Area Covered In The Session:

  • Provision of Service
  • Maintenance of Medical Records
  • Survey Preparedness
  • Billing Practices
  • Corporate Compliance Officer
  • Rehabilitation compliance training
  • Non-retaliation policy
  • Auditing and monitoring
  • Regulatory education
  • Screening and Evaluation of Employees
  • Quality of care
  • Compliance Program effectiveness
  • Policies and procedures to enhance compliance
  • Prevent, detect, respond, report and resolve behaviors
  • Commitment to Compliance

Target Audiences:

  • Rehabilitation Directors
  • Therapy professionals
  • Administrators
  • Nurse Managers
  • Utilization Review/Quality Improvement Staff

Our Speaker Profile:

Elisa Bovee has been working in the health care environment advocating for patients through education and clinical guidance for over 20 years.  With a Masters degree in Occupational Therapy she has extensive experience managing Operations on a national level. Along with her team, Elisa works with health care providers on clinical, regulatory and reimbursement strategy.  Her expertise includes Compliance Programs, Regulatory guidelines, development of Education programs, Reimbursement and skilled documentation for nursing and therapy professionals. Managing claims through the Development Request and Denial phases is Ms. Bovee’s forte.  Elisa presents programs nationally targeting all interdisciplinary groups seeking guidance and clarity on a multitude of Regulatory and clinical topics. Elisa has written and contributed to articles for numerous national trade publications.