Medicare Audits/Medicaid Audits

This process assesses current processes related to Medicare PPS and/or Medicaid. This includes a three-phased approach including: Clinical Assessment and Consultation, Rehabilitation Assessment and Consultation; and Financial Assessment and Consultation for Medicare PPS. A facility may choose to complete one or all of these phases. The Medicaid Assessment includes the Clinical Assessment and Consultation phase only.

Clinical Assessment and Consultation
Boyer & Associates will meet with the facility staff to understand and assess current processes related to Medicare PPS and/or Medicaid.

Assessment areas include resident admission process, the MDS scheduling and completion process, accuracy and consistency of documentation in the clinical record, and communication processes between clinical and billing and among the different areas of clinical practice.

Rehabilitation Assessment and Consultation
Boyer & Associates will meet with the facility staff to understand and assess current rehabilitation processes as they relate to Medicare PPS and Medicare Part B coverage and documentation. During our visit, we will review resident charts to evaluate therapy practices and documentation.

Financial Assessment and Consultation
This phase is completed off-site after the completion of the onsite clinical and/or rehabilitation assessment.

Assessment areas include: Medicare secondary payer process, denial letters and expedited review process, uniformity of charge structures, billing practices, Medicare Log maintenance, medical review practices and denials management.

          

Corporate Compliance Audits/ Independent Review Organization

This includes assessment of Medicare billing for clients either under a Corporate Integrity Agreement (CIA) with the Office of the Inspector General (OIG) or as part of their internal corporate compliance program. As part of this process, claims are selected utilizing the RATs-STAT program utilized by the OIG. A random sample will be selected based on a claims listing submitted by the client. A probe sample selection of 50 claims is typically selected. Our consultants will then go on-site in the facility and analyze the claims. This includes reviewing the MDS to ensure that the RUGs level billed is supported by the assessment and that the UB-92 has been completed correctly. We look for opportunities of increased reimbursement as well as overbilling. A financial analysis will be completed that nets overpayments and underpayments. If a facility is under a CIA with the OIG, this provides the basis for the clients annual reporting to the OIG. For facilities who are completing this process as part of their Corporate Compliance program, this information gives the facility information for educational needs and ongoing auditing processes.

          

Operational Assessment

Assessment of operational efficiency in Continuing Care Retirement Communities (CCRCs), senior housing, nursing home facilities, and assisted living centers. This process may include assessment of clinical systems, ancillary services, staffing analysis, business office functions, dietary services, admissions process or any other department as identified by the community. In addition, we analyze management personnel and department managers. As part of the clinical systems and staffing analysis we examine the structure of nursing staffing to improve operational efficiency. This analysis can include the independent living, assisted living, and/or skilled nursing facility (nursing home) as identified by the client. This assessment can be as limited or as encompassing as needed as defined by the client.

Some times providers of senior housing or healthcare will request this type of review to improve their internal operational efficiencies and their overall financial condition. Many times this type of assessment is completed when a nursing home or Continuing Care Retirement Community is finding they are not meeting their financial objectives or they have breached their financial covenants committed to in their Bond negotiations. We have a proven record of assisting nursing facilities (nursing homes), assisted living centers and CCRCs in improving financial performance and positioning themselves for financial loans.

          

Mock Surveys

In our present regulatory environment, many Long Term Care facilities and assisted living centers are finding themselves needing extra assistance in evaluating their survey readiness. Through our mock survey process, our staff provides the expertise to assist your facility in evaluating all departments to ensure they meet State and Federal requirements for licensure and certification. The same process utilized by the survey team will be implemented in the mock survey process which assists your facility in understanding the survey process, practice in managing the survey process and identification of potential deficiencies what could be identified by the survey team. We will identify potential deficiencies and the scope and severity of each potential deficient area as a result of the mock survey.

The mock survey review includes focus and education on new regulatory requirements for your assisted living center or nursing home including new requirements for:

• F248, F249 - Activities
• F250, F251 - Quality Assessment and Assurance
• F314 - Pressure Sores
• F315 - Incontinence Care
• F334 - Influenza and Pneumococcal Immunization
• F501 - Medical Director
• Psychosocial Outcome Severity Guide

In addition, we provide your assisted living center or skilled nursing facility (nursing home) with a detailed report of the mock survey identifying the potential regulatory violation, the scope & severity of the problem, and the teams observations and recommendations for correction. Boyer & Associates will also provide you with available resources to correct deficient practices.

          

Educational Workshops

Boyer & Associates professionals are recognized as experts in providing educational workshops at national, state and facility levels. We provide custom workshops for individual clients, communities, provider organizations including state and national organizations on a variety of clinical and operational subjects focused on senior housing and healthcare. The following workshops are an example of our presentations:

Acuity-Based Staffing Model: Utilizing the Case Mix Systems to Staff Your Facility	Length: 4-6 hours
ADLs: Code it Right, Every Time!	Length: 2 hours
Advanced MDS 2.0 . . . The Crucial Link to Clinical Resources and Quality Indicators	Length: 2 hours
And the No. 1 Citation is…F371, Food Safety!	Length: 4-6 hours
Back to the Basics: Restorative Nursing Techniques for Staff	Length: 5-6 hours
Basic MDS 2.0 . . . From the Beginning	Length: 4 hours
Clinical Documentation: There's More to it Than Dotting the "i's" and Crossing the "t's"	Length: 1.5-2 hours
Corporate Compliance: What You Don't Know Can Hurt You	Length: 2-4 hours
Dietary Cost Considerations Under PPS	Length: 1-2 hours
Efficiency + Quality = Profitability	Length: 4-5 hours
Financial Management for Department Managers	Length: 3-3.5 hours
Fine Dining on a Budget	Length: 1-2 hours
Food For Thought: Restorative Dining	Length: 2-3 hours
Functional Assessment for Assisted Living: A Clinical and Financial Tool	Length: 3.5 hours
Implementing Effective "Teaching and Training" Strategies	Length: 1.5-2 hours
Incorporating QM/QIs into Your Facility's QA/CQI Program	Length: 2-3 hours
Incontinence Care: Meeting the New Federal Requirements	Length: 3-4 hours
Introduction to Medicare Billing	Length: 8 hours
Management Hors d'oeuvres: An Appetizing Array of Bite-Size Management Morsels	Length: 1.5 hours
Managing the Survey Process	Length: 3-4 hours
MDS Accuracy: Positioning Your Facility for Clinical and Financial Success	Length: 3-6 hours
MDS . . . Minding Your Facility's Ps and Qs (Payment and Quality Indicators)	Length: 5-6 hours
MDS: The Cornerstone to Clinical and Financial Success	Length: 3-6 hours
MDS 2.0: The Crucial Link to Resources and Reimbursement	Length: 6 hours
Medical Review - Dealing With Denials	Length: 2-3 hours
Medicare Billing Under PPS: Don't Gamble With Your Facility's Revenue	Length: 6 hours
Medicare Documentation: Getting It Right the First Time	Length: 4-5 hours
Medicare PPS: Positioning Your Facility for Financial Success	Length: 5-6 hours
Operation: Restorative Nursing	Length: 4-6 hours
Performance Management - Tying It All Together	Length: 4-5 hours
Positive Operational and Clinical Outcomes . . .The Nurse Manager Model	Length: 5-6 hours
Preventing Falls: A Complex Interdisciplinary Approach	Length: 1-2 hours
Prospective Payment System: Clinical Implications	Length: 5-6 hours
Quality Indicators: What Every Clinician Needs to Know	Length: 5-6 hours
Re-Engineering Nursing for PPS Service Delivery	Length: 1.5-2 hours
Rehab Compliance: Is Your Facility At Risk?	Length: 3-3.5 hours
RUGs III Medicaid: Clinical Implications (State specific for Colorado, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Montana, Nevada, North Carolina, Ohio, Pennsylvania, Virginia, and Washington)	Length: 4-6 hours
ServSafe Food Safety Program Certification Course	Length: 8 hours
The Seven Habits of Highly Effective PPS Managers	Length: 3-5 hours
The Seven Habits of Highly Effective Medicaid Managers	Length: 2-6 hours
The Seven Habits of Highly Successful Assisted Living Managers	Length: 2-2.5 hours
Show Me the Money!!	Length: 1 hour
Skin Care Management: The New Requirements for F314	Length: 2-3 hours
Successful Care Planning Strategies	Length: 4-6 hours
Therapy Operations: Building Blocks for Success	Length: 6 hours
Turning Back the Clock: 11 Ways to Improve ADL Self-Performance Through Restorative Nursing	Length: 5-6 hours
Water, Water Everywhere, But Not a Drop to Drink…?	Length: 1-2 hours
What's New with Medicare Billing? An Update of Recent Changes in Medicare Part A & Part B Billing	Length: 4 hours
Reduce Your Worker's Compensation Cost!	Length: 5-6 hours
Accident Investigation; Root Cause Analysis	Length: 1-2 hours
Insignts on Pain; Myths about Fraud	Length: 1-2 hours
Move Safely, Cut Costs - A Comprehensive Transfer / Mobility Program	Length: 5-6 hours
Reduce and Control Combative Behaviors	Length: 1-2 hours
Implementation of a Workplace Stretch Program	Length: 2-3 hours
Cool Customer Relations: Responding to and Managing Customer Complaints	Length: 5-6 hours
Survey Readiness	Length: 4-5 hours
Standards of Practice	Length: 4-5 hours