CMS to slow payments of noncompliant claims
Beginning July 1, 2004, the Centers for Medicare & Medicaid Services (CMS) will pay claims no earlier than 27 days after receipt of the claim instead of the current 14 days, if the claim is not compliant with the Health Insurance Portability and Accountability Act (HIPAA) transactions standard.
While CMS calls the operational change an incentive to meet HIPAA standards and a "measured step toward ending the contingency plan for payment of electronic claims," others claim that it unfairly penalizes some organizations. Lawrence Hughes, regulatory counsel for the American Hospital Association points out that "slowing down payments burdens and penalizes only the provider when the problem may be a trading partner who is not ready to use, transmit, or accept the standardized transactions. It doesn’t create an incentive for other critical partners involved in the transactions process, such as vendors, clearinghouses, or carriers, to cooperate and work diligently with providers in moving compliance forward."
10 most common health care mistakes by seniors
Based upon information gathered for educational courses and books, the Institute for Healthcare Advancement (IHA) in La Habra, CA, has identified the 10 most common health care mistakes made by seniors.
"Seniors are enjoying themselves and remaining active much later in life," says Gloria Mayer, RN, EdD, president and chief executive officer of IHA. "But they must also take charge of their health care," she adds.
By identifying key areas in which seniors make mistakes, the institute hopes to further education of seniors as well as family members. The most common mistakes identified by IHA are:
- Driving when it’s no longer safe
- Fighting the aging process and its appearance by refusing to wear eyeglasses, hearing aids, or dentures as well as refusing to use walking aids
- Reluctance to discuss intimate health problems such as urinary difficulties with a doctor or health care provider
- Not understanding what the doctor has told them about their health problem or medical condition and not asking for further explanations
- Disregarding the serious potential for a fall by keeping scatter rugs and poor lighting in their homes
- Failure to have a system or plan, such as pillboxes, written daily schedule, or check-off record, for managing medications
- Not having a single primary care physician who looks at an overall medical plan for treatment to avoid multiple medical regimens that might cause adverse reactions
- Not seeking medical attention when early possible warning signs occur
- Failure to participate in preventive programs
- Not asking loved ones for help for reasons such as stubborn personalities, a desire for independence, or early signs of dementia
An easy-to-read, easy-to-understand self-help book for senior citizens — What to Do for Senior Health — has been published by IHA. For information or to order the book, call (800) 434-4633 or go to www.iha4health.org and click on "Bookstore" link. The cost of the book is $12.95.
Self-disclosure reduces penalties
A hospital in Greenville, SC, will pay nearly $9.5 million to resolve Medicare billing improprieties from 1997 through 1999 in its home health, hospice, and durable medical equipment programs, the Office of Inspector General (OIG) announced recently. The settlement is the largest reached in such cases. Dara Corrigan, acting principal deputy inspector general, announced the settlement with St. Francis Hospital, which self-disclosed the improper billing.
When purchasing St. Francis in 2000, Bon Secours Health System discovered billing and documentation problems at the hospital. Bon Secours then launched an internal investigation that revealed "significant error rates and systematic documentation lapses" in St. Francis’ Medicare billings, Corrigan said. The hospital brought its findings to OIG under the Self-Disclosure Protocol, which encourages providers to approach the government voluntarily when they uncover evidence of potential fraud and compliance problems in their organizations.
Under the Self-Disclosure Protocol, OIG outlines how providers should investigate and audit compliance problems and how OIG will work with disclosing providers to resolve the situation. Corrigan said St. Francis was subject to much higher penalties than the settlement amount, but because the organization self-disclosed and quickly took corrective steps to remedy the problems, OIG took a cooperative approach to remediation.
Improving outcomes in pain management
Kathleen Rose, RN, MSHSA, president and CEO of Vineyard Nursing Association, and Sandi Corr-Dolby, RN, clinical director of Vineyard Nursing, will present "How to Integrate Pain Standards and Palliative Care Principles into a Home Care Agency: A Case Study" at the 22nd Annual Meeting and Exhibition of the Visiting Nurse Associations of America. The educational conference will be held April 21-23, 2004, at the Hyatt Regency in New Orleans.
In their 90 minute program, Rose and Corr-Dolby will demonstrate how Vineyard Nursing, a full-service home care agency located on Martha’s Vineyard Island 25 miles south of Cape Cod, MA, has achieved measurable improvement in its chronic pain management program since implementing new administrative and clinical procedures developed by Pain Resources Network (PRN) of Melrose, MA.
PRN president Cathy Schutt, RN, MS, ANP, will join Rose and Corr-Dolby in discussing how systemwide changes and interactive clinical tools have helped Vineyard Nursing meet or exceed the standards recommended for pain and palliative care by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other regulatory agencies.
"We knew our staff members were highly skilled in traditional curative care practices, but the long-term nature of illness experienced by a large percentage of our client population made us realize that we needed to improve the quality of the palliative care we delivered as well," Rose explains. "To do this, we needed to address our chronically ill patients’ very subjective pain and symptom management needs more consistently and effectively. We wanted to adopt a comprehensive, interdisciplinary approach to patient care that would view pain as the fifth vital sign. We wanted to integrate the diagnosis and treatment of pain and its related symptoms into our daily clinical routine."
Pain Resources Network worked with Vineyard Nursing to assess the situation, establish goals and objectives, redesign administrative and clinical practices and procedures to accommodate the implementation of recommended pain standards, and train the entire interdisciplinary team in effective pain management and palliative care.
PRN also developed hands-on clinical tools that would help each member of the health care team assess pain more accurately, carry out appropriate interventions more confidently, and communicate more consistently with patients, families, and each other.
"We at Vineyard Nursing are now very confident when dealing with our patients’ chronic pain symptoms," Rose says. "The ways in which our staff interacts with patients, families, MDs, and colleagues are measurably more consistent and effective. Our pain and palliative care outcomes have achieved the standards of care set forth by JCAHO, and we have significantly improved the quality of life for those patients who are not heading toward a cure. We are very committed to continuing this program and to training others with whom we work as well."
The pain management and palliative care program being used by Vineyard Nursing is available to all health care providers in the form of an implementation and training system called Integrating JCAHO Pain Standards: Strategies and Tools for Non-Acute Settings, published by Pain Resources Network.
For information, go to www.painstandards.com or call Kris Gravina at (781) 620-1919.