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Affordable Care Act Puts Post-Acute Care Facilities under Increasing Scrutiny

Improved healthcare for patients and substantial Medicare savings are the motivations behind the Affordable Care Act’s call for increasing scrutiny of post-acute care facilities; long-term care facility owners and operators need to take notice.

Revised nursing home rating systems

President Obama signed the Improving Medicare Post-Acute Care Transformation Act (IMPACT) Oct. 6 changing the way nursing homes are rated. IMPACT expands and strengthens the Five-Star Quality Rating System, rating system that consumers can use to evaluate nursing homes. The reports focus on staffing levels, pressure ulcers, use of restraints and the details of injurious falls in nursing homes.

Hospital readmission rate penalties

It’s not just regulators doing the scrutinizing. Penalties to hospitals’ Medicare reimbursement rates with high 30-day readmission numbers, has prompted hospital administrators to assess the post-acute care facilities they transition patients to. Facilities with high 30-day hospital readmission rates are receiving fewer patient referrals.

post-acute-care-facilities-costsCloser examination of Medicare bills

Medicare will be examining bills submitted to it from long-term care facilities and healthcare practitioners more closely, and the Department of Justice is renewing its focus on prosecutions for fraudulent Medicare and Medicaid billing practices.

Sunshine Act

Formally known as The Physicians Payments Sunshine Act, and called the Open Payments Act by the Centers for Medicare and Medicaid Services (CMS), which is charged with implementing it, it requires manufacturers of Medical devices, drugs and biologicals that participate in federal healthcare programs to be transparent about payments and items of value given to physicians and teaching hospitals.

Reporting overpayments

Improving payment accuracy from Medicare and Medicaid to providers must be done within 60 days or risk action under the Federal False Claims Act. CM defines overpayment “as any funds received or retained to which the plan, after applicable reconciliation, is not entitled,” according to the Mintz Levin Health Law website. CEOs, CFOs and COOs must verify that the report is accurate, complete and truthful.

 General Medicine, The Post-Hospitalist Company provides onsite physician services that specialize in the care of post-acute patients living in long-term facilities. Our post-hospitalists also monitor, maintain and report compliance of government laws and regulations.

Tom Prose