Your Complete Policy Management Partner
Everything your healthcare organization needs to confidently maintain accreditation compliance.
Robust document control and workflow management software solution
Simplify & automate policy access, review and approval across your organization
Web-based library of more than 18,000 customizable policy documents
Instantly access up-to-date policies, procedures & forms authored by MCN experts
Automated regulatory notification system of daily email or mobile alerts
Keep current with regulatory changes from more than a dozen federal regulatory bodies, including TJC & NIAHO
What Our Customers are Saying
MCN Healthcare has been indispensable to our accreditation compliance efforts. With Policy Manager, Policy Library and StayAlert!, we have peace of mind that our policies will always be up-to-date and easy to locate.
Beverly McKenzie, Compliance Programs Director, IASIS Healthcare
Helpful MCN Healthcare Resources
The Office of Inspector General recently released its 2015 Work Plan; today's notice is a summary of high-interest areas of focus for Medicare Home Health Agencies. The 2015 Work Plan outlines compliance and enforcement projects and priorities OIG intends to pursue in the coming year. Both areas where OIG will concentrate their efforts this year are ongoing work from 2014.
Home Health Agencies:
- Home health prospective payment system requirements: OIG will review compliance with various aspects of the home health prospective payment system (PPS), including the documentation required in support of the claims paid by Medicare. They will determine whether home health claims were paid in accordance with Federal laws and regulations. A prior OIG report found that one in four HHAs had questionable billing. Further, CMS designated newly enrolling HHAs as high-risk providers, citing their record of fraud, waste, and abuse.
- Employment of individuals with criminal convictions: OIG will determine the extent to which home health agencies (HHAs) are complying with State requirements for conducting criminal background checks on HHA applicants and employees. A previous OIG review found that 92 percent of nursing homes employed at least one individual with at least one criminal conviction; however, that review could not determine whether the nursing home employees should have been disqualified from working in nursing homes because OIG did not have access to detailed information on the nature of the employees' crimes. Federal law requires that HHAs comply with all applicable State and local laws and regulations. (Social Security Act, §1891(a)(5), implemented at 42 CFR § 484.12(a).) Nearly all States have laws prohibiting certain health-care-related entities from employing individuals with prohibited criminal convictions.
In our ongoing review of the 2015 Office of Inspector General Work Plan, today's notice reviews areas of focus for Medicare Equipment and Supplies. The 2015 Work Plan outlines compliance and enforcement projects and priorities OIG intends to pursue in the coming year. Topics included in this year's work plan include:
EQUIPMENT AND SUPPLIES - POLICIES AND PRACTICES
- Power mobility devices-Lump-sum purchase versus rental: OIG will determine whether potential savings can be achieved by Medicare if certain power mobility devices (PMDs) are rented over a 13-month period rather than acquired through a lump-sum purchase.
- Competitive bidding for medical equipment items and services-Mandatory post-award audit: OIG will review the process CMS used to conduct competitive bidding and to make subsequent pricing determinations for certain medical equipment items and services in selected competitive bidding areas under rounds 1 and 2 of the competitive bidding program.
- Competitive bidding for diabetes testing supplies-Market share review: OIG will determine the market share of different types of diabetes test strips for the 3-month period of October through December 2013.
EQUIPMENT AND SUPPLIES - BILLING AND PAYMENTS:
- Power mobility devices-Supplier compliance with payment requirements: OIG will review Medicare Part B payments for suppliers of PMDs to determine whether such payments were in accordance with Medicare requirements.
- Power mobility devices-Add-on payment for face-to-face examination: OIG will review Medicare Part B payments for PMDs to determine whether the Medicare requirements for a face-to-face examination were met. Medicare requires that the treating physician, when prescribing a PMD, conduct a face-to-face examination to determine the medical necessity of the PMD and write a prescription for the PMD. (42 CFR § 410.38(c)(2).)
- Lower limb prosthetics-Supplier compliance with payment requirements: OIG will review Medicare Part B payments for claims submitted by medical equipment suppliers for lower limb prosthetics to determine whether the requirements of CMS's Benefit Policy Manual, Pub. No. 100-02, ch. 15, § 120, were met.
- Nebulizer machines and related drugs-Supplier compliance with payment requirements: OIG will review Medicare Part B payments for nebulizer machines and related drugs to determine whether medical equipment suppliers' claims for nebulizers and related drugs are medically necessary and are supported in accordance with Medicare requirements.
- Frequently replaced supplies-Supplier compliance with medical necessity, frequency, and other requirements: OIG will review claims for frequently replaced medical equipment supplies to determine whether medical necessity, frequency, and other Medicare requirements are met.
- Diabetes testing supplies-Supplier compliance with payment requirements for blood glucose test strips and lancets: OIG will review Medicare Part B payments for home blood glucose test strips and lancet supplies to determine their appropriateness.
- Diabetes testing supplies-Effectiveness of system edits to prevent inappropriate payments for blood glucose test strips and lancets to multiple suppliers: OIG will review Medicare's claims processing edits (special system controls) designed to prevent payments to multiple suppliers of home blood glucose test strips and lancets and determine whether they are effective in preventing inappropriate payments.
Update on the Investigation of Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children, Fall 2014
The Centers for Disease Control and Prevention (CDC) is working closely with the Colorado Department of Public Health and Environment (CDPHE) and Children's Hospital Colorado to investigate a cluster of pediatric patients hospitalized with acute neurologic illness of undetermined etiology characterized by focal limb weakness and abnormalities of the spinal cord gray matter on MRI.
As of October 23, CDC has verified reports of 51 cases in 23 states meeting the following case definition:
- Patient ≤21 years of age,
- Acute onset of focal limb weakness,
- On or after August 1, 2014, AND
- An MRI showing a spinal cord lesion largely restricted to gray matter.
Persons who meet ALL four of the above criteria should be reported to state and local health departments. The CDC is requesting that state and local health departments report persons meeting the case definition to the CDC using the patient summary form.
The completed patient safety form and available clinical specimens should be submitted to the CDC as soon as possible after case identification so that the CDC can monitor these cases in as real time as possible. A form that is largely complete but has some information pending (e.g., hospital or health department laboratory results) or still under investigation (e.g., polio vaccination history) should still be submitted as soon as possible.
For specimen collection instructions, a link to the patient safety form, and information for parents, follow the link below.
Featured Policy Library Manuals
MCN's NEW Ambulatory Surgical Center/Outpatient Surgery Department Policy and Procedure Manual is cross referenced to TJC standards, AAAHC standards and CMS regulations. Policies and procedures meet AORN and CDC recommendations and guidelines. This comprehensive reference guide has over 290 policies and procedures that are ready to customize to your organization. See also the Administrative Manual for Ambulatory Care Facilities and the Ambulatory Services EOC Manual.Read more »
MCN's Central Service Policy and Procedure Manual provides over 200 proven, up-to-date policies and procedures in a ready-to-customize format. This manual is cross referenced to federal regulations, as well as Joint Commission and NIAHO standards. References used include AAMI Recommended Practices, IAHCSMM Central Service Technical Manual, ASHCSP Training Manual for Health Care Central Service Technicians and AORN Recommended Practices.Read more »
MCN's Post Anesthesia Care Policy and Procedure Manual is a comprehensive resource that covers the latest "hot topic" regulatory and patient safety issues that are relevant to PACU! This manual includes administrative, operational, functional and patient-centered policies and procedures. Policies and procedures are cross-referenced to CMS regulations, Joint Commission standards and NIAHO standards.Read more »