Long Term Care & Senior Living Blog

The Office of Inspector General (OIG) recently released the findings of an audit performed to determine the prevalence of incidents of potential abuse or neglect of Medicare beneficiaries residing in skilled nursing facilities (SNFs). Specifically, OIG looked at beneficiaries who resided in a SNF during 2016 and who also had a hospital emergency room (ER) Medicare claim containing a high-risk diagnosis code. 

CMS issued an update regarding what appears to be a sharp increase in the denial rate for Skilled Nursing Facilities (SNFs) as reported in the 2015 Comprehensive Error Rate Testing (CERT) Report. The CERT Report showed denials increasing from 6.9% reported in 2014 to 11% in 2015. What did CMS attribute as the cause of this significant increase? DOCUMENTATION Here are some documentation requirements that CMS reported for the increase in denials resulting from missing or incomplete certification/recertification including:

The Senior Care Pharmacy Coalition (SCPC) recently released a study comparing the differences between LTC and Retail Pharmacies. I thought this study may be of interest to some firm clients, who have LTC pharmacies as part of their businesses. Many assisted living facilities (ALFs) and skilled nursing facilities (SNFs) provide pharmacy services for residents in their facilities, as well as provide medication therapy management and other clinical offerings to help improve the quality of care. The differences between LTC pharmacy and retail pharmacy often result in greater costs being incurred by LTC pharmacies. To ensure the important role LTC pharmacies play in the healthcare continuum, it is important that lawmakers and regulators understand the differences demonstrated in the study. Here’s a link to the SCPC article, and a link to the actual study conducted by Avalere Health.