In the annals of oops, there are career-enders, Hall-of-Fame makers, kitsch oops, the off-with-your-head oops and the oops that wake us, screaming, from our sleep. The fine folks at CMS, not to be outdone, have discovered a widespread hospital oops, affecting the Medicare benefits of people in at least three states.*
It appears that certain auditors goofed while performing their Recovery Audit Contractor (RAC) duties, and, well, hospitals started changing patients from “inpatient” to, um, not-inpatient. When the hospital staff tried to convince the auditors to give this another thought, they were given the old Major Major treatment. Result: automatic denial of skilled nursing benefits for patients in Utah, California, and Arizona, and maybe elsewhere.
Last week, CMS did their best to get everyone to remain calm. The agency issued a “Technical Director Letter” to the contractors, telling them, in polite bureaucratese, to straighten up and fly right. No later than Wednesday, contractors will have to post on their Web site that the old rules are, um, inoperative.
“Once the MACs post the information, [skilled nursing] providers that have received this edit in error may adjust their affected claims or contact their MAC in order to have their claims adjusted,” CMS Associate Regional Administrator Barbie Robinson says in a letter to the fine folks at AHCA/NCAL.
Now, it is notorious that the providers and auditors view each other much like the sans-culottes viewed Louis. And CMS is doing its level best to play Tom Paine in this little costume drama. But providers can perhaps be forgiven if they allow themselves a wintry, Madame DeFarge-esque smile: They saw this Bastille Day coming for a long time.
“I believe that CMS is struggling with the unintended consequences of RAC hospital audits, the new hospital two-midnight and rebilling regulations, and the hospital provider confusion that much of this has unintentionally caused,” one long term and post-acute care advocate has said. “And now this confusion on the part of both hospitals and MACs is indirectly hitting us.”
Meanwhile, more pleasant news from the Revolution. The fine folks at AHCA/NCAL have announced their new class for their own Legion d’honneur. Every year, the groups recognize the best and the brightest of their profession, “the men and women who give freely of themselves in caring for individuals in long term and post-acute care centers, ID/DD residences, as well as assisted living communities.”
This year’s honorees are:
- Hero of the Year — Intellectual and Developmental Disabilities: Alicia Durham, Eureka, CA, who volunteers at Butler Valley Inc., Carole Sund Center.
- Not for Profit Program of the Year: St. Benedicts Health Center and Benedict Court, Dickinson, ND.
- Volunteer of the Year — Adult: Ruth-Ann Harrod, Wesley, ME, who volunteers at Maine Veterans’ Home.
- Volunteer of the Year — Group: Amory High School Health Class, Amory, MS, which volunteers at Golden Living Center, Amory.
- Volunteer of the Year — Young Adult:Bailey Austin Combs, Amburgey, KY, who volunteers at Knott County Health & Rehabilitation Center.
Vive le republique (and all that).
*Your humble correspondent isn’t above an oops of his own: In an earlier draft of this scintillating post, I neglected to add the extra “n” in “annals.” I offer the mote in my own eye: with Muphry’s Law, c’est la vie.
Bill Myers est rédacteur principal d’Magazine Fournisseur. Email à email@example.com . Suivre sur Twitter, @ProviderMyers.