Meet Robert Hussar - RecoverCare

Compliance TODAY October 2012

a publication of the health care compliance association

www.hcca-info.org

Meet Robert Hussar Perspective from someone who has played 4 different compliance roles: ·

Compliance Officer

·

Consultant

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Health Law Attorney

·

State Medicaid First Deputy IG

See page 16

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A timeline for change: A discussion of the Affordable Care Act provisions

Hospital self-audits of “provider-based” status

Bruce A. Johnson and Joseph T. Van Leer

Lawrence W. Vernaglia and Jeffrey R. Bates

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Reimbursement for quality-of-care issues: What’s a signature worth?

HIPAA Notice of Privacy Practices: Don’t forget the basics

Susan Nance

Elizabeth A. Kastner

This article, published in Compliance Today, appears here with permission from the Health Care Compliance Association. Call HCCA at 888-580-8373 with reprint requests.

by Susan Reinach-Lannan, BSOM

Maintaining compliance in the durable medical equipment world »» Finding resources for regulatory and compliance guidance for hybrid durable medical equipment providers can be a challenge. »» A successful corporate compliance program in a company with more than 130 locations in 47 states and 850 employees is possible. »» A durable medical equipment sales force may need convincing that “sales at any cost” is bad business. »» For field operations, maintaining compliance is just as important as delivering equipment as fast as you can to a customer.

Susan Reinach-Lannan ([email protected]) is the Compliance Officer for RecoverCare, a national distributor of specialty wound care equipment, in Louisville, KY.

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irst of all, let me say, I love my job. I have more than 30 years of health care experience, and the past nine years I’ve been with a durable medical equipment (DME) company that services both the home care patient and the acute care/long-term care patient. My company specializes in support surfaces for wound care, negative pressure wound therapy pumps and supplies, bariatric equipment, and safe patient handling solutions. The position of Compliance Officer was a metamorphosis of several positions Reinach-Lannan I have had over the past nine years, and I have to say, I am never bored. I have had good days and not so good days, but if I have a not so good day, I just wait, because tomorrow will bring a whole new host of challenges, some good, some not so good, but definitely different from the day before. The biggest challenge I have faced is finding resources for regulatory and compliance

guidance that are pertinent to the hybrid durable medical equipment provider. The 30 Medicare DMEPOS Standards (Durable Medical Equipment, Prosthetics, Orthotics and Supplies)1 have been and continue to be wonderful guidelines, but most information out there is geared towards the acute care market as well as the physician’s office. I have purchased books, read articles, attended conferences, and asked for advice from several sources, and I still do not feel I have good resources to call upon for every situation. It has been trial by fire in some instances. I know I am not alone in this vast wasteland. There have to be others like me in the health care world, and I would like to share my experiences in the hopes that any of you lost souls out there in the durable medical equipment/home medical equipment (DME/HME) world can glean some useful information.

Medicare reimbursement Let’s start with Medicare compliance. The one constant that every health care provider can be sure of is that the rules of reimbursement will 888-580-8373 www.hcca-info.org

Compliance Today October 2012

»» Corporate officers and executives may require education to see that compliance, quality, and profitability can work together to maintain a viable and successful company.

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continue to change. Whether those changes are beneficial to the patient is always the question on everyone’s mind. This has never been more evident than with the advent of competitive bidding, and in acute care and long-term care settings with decreased reimbursement. Nurses, clinicians, billers, and coders are constantly challenged when making patient care decisions that will fit into today’s guidelines of Medicare reimbursement. And if you are unsure today, be prepared—the rules will change tomorrow. It becomes especially challenging for those companies and individuals who specialize in caring for patients both at home and in facilities. Medicare is quickly moving towards a reimbursement system that is based on quality of care and clinical outcome data. The Patient Protection and Affordable Care Act of 2010, as amended by the Health Care Education Affordability Reconciliation Act of 2010 (commonly referred to as Healthcare Reform) will force a change in how providers will be reimbursed. Within a couple of years, Medicare reimbursement will be based on quality of care and clinical outcome study results, not just the quantity and type of care provided. Providers will be rewarded if they meet certain quality measures defined by Medicare, but those who do not meet them will be penalized through lower reimbursement. The basic diagnosis-related group (DRG) payment amount is scheduled to be reduced yearly for the next few years and level out at 2% by Fiscal Year 2017.2 The percentages appear low in the overall reimbursement to a health care provider, but this is a significant decrease in reimbursement that will have to be offset in some other way in order for the business to remain viable.

Tips to maximize reimbursement However, all is not lost, and caring for patients in all arenas can still result in reimbursement,

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as long as attention to detail is followed by the health care providers. Here are some tips I have found that can help maximize reimbursement for durable medical equipment. HCPCS coding Make sure the products and services provided by your company are HCPCS coded. The Healthcare Common Procedure Coding System (HCPCS) was established in 1978 to provide a standardized coding system for describing the specific items and services provided in the delivery of health care.3 This coding is necessary for Medicare, Medicaid, and other managed care programs to ensure that the claims are processed in an orderly and consistent manner. I have worked with a few of our suppliers in getting Medicare DME Pricing, Data Analysis and Coding (PDAC) applications submitted for products we would like to use in the home care setting. Patient qualifications Make sure that current labs and nutritional assessments are on file in the patient’s chart. Medicare requires the patient to qualify for certain products and services. Having this documented in the patient’s file as evidence that the patient qualifies for the product(s) or procedure will go a long way to prevent requests for repayments during a Medicare audit. Acuity level Have the referring agency take measurements of wounds and chart/stage them correctly in the patient’s file. The acuity level of the patient will dictate the product and services that Medicare will reimburse to the health care provider. Document evidence of healing If necessary, and if warranted, suggest the referring agency take pictures of the wounds and use wound assessment tools to track healing. Remember to chart everything in the

Invest in the right staff A good Billing/Coding department is a must for any health care provider or organization. A coder who knows her way around ICD9 and ICD10 codes can make or break obtaining proper reimbursement. An organization can invest wisely in hiring the right billing/coding team, make sure that they have the proper software, and stay abreast of changes in this area. In addition, having an Auditing department that can recognize any issues with billing/ coding errors up front can prevent future audits and requests for repayments from CMS. Delivery considerations Make sure the delivery staff is trained in the subtle differences of delivering to a home care patient as opposed to a facility patient. It can take twice as long to deliver to a home care patient, and taking the time to make sure the client and/or caregiver is properly informed about the correct use and care of the equipment is a must. Providing information regarding the home assessment/risk for fall is also a must. Providing quality equipment while maintaining safety and infection control can go a long way to prevent issues that may trigger a client complaint and Medicare audit. Medicare is encouraging beneficiaries to report anything out of the ordinary. Follow up Make sure you follow up monthly with the patient and/or caregiver to assure they are still at home and more importantly, are not deceased. This can be just a “calling to check in and make sure everything is okay with the equipment” courtesy call. I cannot tell you the number of claims I have seen denied because the patient had a hospital admission just after the rental commenced or else was deceased

and the provider never was made aware of the hospitalization or death. A proper intake process with complete beneficiary, insurance, and caregiver information will also help to maintain a proper file and guarantee continuity of care for the patient. Monthly monitoring of your home care patient charts will alert you to anything out of the ordinary that is missing or incomplete. Train your field staff Have a good training program in place for your field staff. My company is Joint Commission accredited and we have mandatory yearly training for all staff, but more importantly, our field staff is required to keep their training updated. We train by various methods—some are self-study modules, some are interactive webinars, and others are classes that are held either onsite or the staff travels to the corporate office for training classes. They also meet the corporate staff and put a name to a face. Our district operations managers are very engaged with their staff to assure compliance. We have a Quality Team who travels the country, visiting every accredited location at least twice per year to perform mock surveys to identify and correct deficiencies within the location. Employees are trained on the importance of adhering to both state and federal regulatory and licensing guidelines. In addition, as the compliance officer, I am very hands-on with our field locations, traveling occasionally to their areas just to ask “What can I do to help you maintain compliance and make your job a bit easier.” Do we still have issues arise periodically? Of course; what company doesn’t? But keeping an open door policy and keeping your staff engaged in decision-making and reviewing of existing policies goes a long way in maintaining the proper compliance. I cannot be in all places at all times, so providing the tools to the district operations managers and making sure they engage their staff has made compliance a lot easier. 888-580-8373 www.hcca-info.org


patient’s file. Remember, in health care, if it wasn’t documented, it didn’t happen.

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Maintaining a detailed data base of all licenses and permits for each state in which your company does business will assure your compliance to state and federal regulations. Medicare is checking licenses now and so are accrediting bodies. In addition, make sure all regional locations are set up to receive mail. A lot of regulatory bodies will mail correspondence regarding licensure to the dispensing location only. Our staff is trained to fax or scan/email to me anything they get in the mail that looks like it may be regulatory in nature. Sales compliance Engaging the sales staff is probably the biggest challenge of all in this position. When your livelihood depends on commissions, it is understandable that a company can become totally sales driven. Without sales, you have no company. However, without operations supporting sales, you have no sales. And if your sales team is violating anti-kick back and Stark laws in order to close a sale, you have a huge problem that can shut your company’s doors. Again, training, communication, and accountability can help engage your sales team in order to maintain a viable corporate compliance program. Engage with Sales and Marketing every chance possible when they have client issues. Participate in conference calls with clients, have documents ready for salespeople to provide to clients and, in general, make sure that the sales staff is able to obtain the answers they are seeking when they are trying to determine what they can and cannot do for clients and still maintain adequate compliance. Our corporate contract director will send proposals for review and input to make sure we aren’t committing to something we cannot do. Does it work 100% of the time? Of course not. However, having a good back-and-forth dialogue with the sales team and responding promptly to questions can help them become more knowledgeable about the corporate compliance program. Working together, acceptable solutions for both

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the client and the company, and still maintain compliance for the company, will be discovered. Communication My company has an internal newsletter that is sent out via email blast every Friday. I have a portion of this called the Compliance Corner. Each week, I provide a two or three paragraph article on a compliance issue for the newsletter. I invite staff feedback on the articles. I also serve as the HIPAA Privacy Officer as well as Compliance Officer, so I am never without a topic to include in the newsletter. I have had many positive comments from a host of employees when they read something that really hits the core of an issue they are having in their region or territory. This is an excellent way to educate the staff and get their buy-in for the corporate compliance program. Executive-level support As to convincing our executive team regarding the importance of compliance, luckily for me, we have a fairly new executive team which includes my boss. As the legal counsel for the company, she is very good about taking the compliance stand during leadership and board meetings, and has taken information I have provided her, as well as information she has received from other sources, and presented it in such a way that our executives are thoroughly engaged in our compliance initiatives. It hasn’t always been this way though. For those of you who work in smaller companies and think you can fly under the radar, let me tell you it doesn’t happen that way. In addition, without executive buy-in, a compliance officer is a salmon swimming upstream. Whether you are company of 50 or 500 or 5,000, compliance should be part of your everyday function. All employees, from the CEO down to the delivery driver, should be trained and aware of regulatory and compliance program initiatives taking place in the company. Placing a compliance topic on the

agenda at every board or committee meeting and having a 10-15 minute discussion will keep compliance at the forefront of the executives. Here are some of the resources I have found very helpful in obtaining information and training material: ·· HCCA and SCCE: As a member of both HCCA and SCCE, I have access to all their resources and have used them repeatedly. Attending the regional and national conferences has been very helpful in finding out information. The weekly emails and Compliance Today are also most helpful in finding out what’s new in the Compliance world. ·· The MLN (Medicare Learning Network): Most of their webinars are free! You can subscribe to all regions “listserve” and stay updated on the latest and greatest news for Medicare, as well as attending the free webinars. ·· FDA and OIG Federal Registry: Subscribing to these will assure you that you have the latest updates to any rule or regulation, without playing the Easter egg hunt game, trying to find out what has changed. ·· MiraVista (http://www.miravistallc.com/ recent_services.php): Medicare consulting

services for DME suppliers and pharmacies gives very reasonably priced webinars packed full of information. ·· Electronic news letters: HME Today, for example. You can stay updated in the most recent licensing and regulatory information and they are free! You cannot get much better than free. In closing, yes Virginia, you can maintain compliance in the DME/HME world by being resourceful, seeking out information, networking with your peers, and maintaining membership in organizations geared towards health care compliance. Providing yearly education, maintaining accountability, and having a good quality audit program will assure that you can maintain compliance and can result in a win-win for employees and executives alike.

1. CMS Medicare DMEPOS Supplier Standards. Available at http://www.stlmedical.com/store/patient-supplier-standards.html 2. Carla M. DewBerry; Stephen Rosen. Hospital Medicare Reimbursement: “Moving to Reimbursement Based on Quality of Care.” Washington Healthcare News. July 2010. Volume 5, Issue 7. http://www.wahcnews.com 3. Glenda J. Motta, RN. MPH. ET. “Wound Care Product Reimbursement: A Guide to HCPCS.” Wound Source. February 17, 2010. http://www.woundsource.com

Don’t forget to earn your CHC CEUs for this issue Complete the Compliance Today CEU quiz for the articles below from this issue:

You may also fax or mail the completed quiz to CCB:

·· Hospital self-audits of “provider-based” status by Lawrence W. Vernaglia and Jeffrey R. Bates (page 33)

mail: Compliance Certification Board 6500 Barrie Road, Suite 250 Minneapolis, MN 55435 United States

·· A systemic review of inter-rater reliability by Kimberly Skiff (page 77) To complete the quiz: Visit www.hcca-info.org/quiz, select a quiz, fill in your contact information, and answer the questions. The online quiz is self-scoring and you will see your results immediately.

Questions: Call CCB at 888-580-8373. To receive one (1) CEU for successfully completing the quiz: You must answer at least three questions correctly. Only the first attempt at each quiz will be accepted. Each quiz is valid for 12 months, starting with the month of issue. Quizzes received after the expiration date indicated on the quiz will not be accepted.

888-580-8373 www.hcca-info.org


·· ICD-10 Procedure Coding System: A provider’s primer to documentation by Susan Theuns (page 51)

Fax: 952-988-0146

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