In certain situations, you will be able to resolve the matter without engaging a law firm. In others, having legal representation provides the best course of action for navigating the beauracratic waters.

Is your agency prepared for a licensing or complaint survey?  Are you expecting surveyors soon?

The old saying, “an ounce of prevention is worth a pound of cure” is truly accurate when it comes to the regulatory oversight of home health and hospice agencies.  Homecare agencies are increasingly at risk for more aggressive regulatory surveys as the industry continues to evolve into one of the most heavily regulated medical fields.  Every homecare agency should work consider implementing pre-survey protocols that include periodic mock surveys to ensure that all aspects of their agency is compliant.  Preparation for surveys should never be limited to simply focusing on clinical charts and patient care.  Job descriptions, human resources activities, quality assurance activities, professional advisory committee meetings and numerous other aspects of agency operations must be evaluated to ensure a clean survey.  Our team can assist with not only mock surveys and quarterly compliance monitoring but also with developing plans and actions to deal with and minimize identified issues.

 

Are DADS’ surveyors at your agency?  Have you recently had a survey with deficiencies?     

Seeking legal advice during and after a survey should not be reserved for only the most serious occasions involving immediate jeopardy claims.  An agency has the right to file an informal dispute of deficiencies, also known as an IROD, anytime surveyors cite your agency with a violation.  Our attorneys and consultants can assist in developing an appropriate and concise response based on both program and regulatory rules.  Our team can also assist in the development and writing of plans of correction that can assist in ensuring compliance during follow up surveys. 

 

Have you discovered a problem with your clinical or administrative files?  What happens with nursing notes that have been forged or unfinished?

Situations involving unethical, careless and inaccurate nursing documentation happen too frequently in homecare.  These issues never involve a single regulatory issue.  A single fraudulent nursing note has the potential to result in numerous licensing and condition of participation violations involving the agency administrator failing to oversee the agency operations, failing to provide ordered services, accusations of the potential for client harm as well as accusations of human resource and internal quality assurance failures.  Immediately becoming proactive by involving your agency’s legal team in assisting with the documentation of corrective actions as well as with taking mandated.

 

I received notice that my license is being revoked.  What do I do?

License revocations are extremely serious and potentially detrimental to an agency.  There are strict rules that govern requesting an appeal of a license revocation.  The first step an agency needs to make is to understand that the Texas Department of Aging and Disability Services' goal is to revoke your license.  Agencies should not seek advice from the department by making contact and trying to "negotiate" an outcome.  An agency's best defense is to hire legal representation as soon as possible.  The process of appealing a license revocation is ultimately handled through the Texas State Office of Administrative Hearings which is an administrative court system.  Strict deadlines for filing an appeal can determine if your agency can continue to operate while the appeal is pending or if you must prepare to discharge your patients and cease operations.

 

I recieved notice that my agency is being assessed administrative penalties.  What should I do?

Administrative penalties can result from findings made by a surveyor during an onsite review or desk review of agency documentation.  Administrative penalties are based on findings that DADS believes they can prove were violations of license regulations.  An agency can appeal DADS' decision to assess administrative penalties.

Much like license revocations discussed above, administrative penalites can be appealed.  The appeal is ultimately handled through the Texas State Office of Administrative Hearing commonly referred to as SOAH.  Strict deadlines for filing an appeal must be considered.  The process of appealing administrative penalites is handled through the legal department at DADS.  Therefore, we recommend that agencies engage the services of an attorney as early in the process as possible.   

 

Are you looking to buy or sell a home health or hospice agency?

Information Coming Soon

 

My agency is preparing to submit a change in ownership due to a reorganization.  The process is so simple. Do I really need a lawyer?

Information Coming Soon

 

Can I contract with a physician or other medical provider?

       Information Coming Soon

 

Fraud is really just high dollar issues, isn’t it?

There are no dollar amounts that establish what actions are fraud.  Fraud is the simple act of billing or keeping any Medicare or Medicaid monies that an agency has reason to believe were not billable.  A pattern of fraudulent billing is not something isolated to the mega dollar fraud cases seen in news headlines.  Homecare agencies frequently identify routine issues during QA and QAPI activities such as an unsigned orders, undated signatures on a plan of care or incomplete OASIS data.  Failure to negatively bill these claims creates a pattern of fraudulent billing activities.  Repeatedly agencies are heard bragging that they received a clean survey.  This is certainly something deserving of bragging rights.  However, regulatory surveys and fraud are completely separate areas of regulation.  Fraudulent activities are more likely found involving violations of the Medicare Claims Manual and Medicare Program Integrity Manual.  Neither of these manuals are considered a focus of surveyors. 

The best defense against allegations of fraud is an aggressive billing compliance program.  Our consultants offer monthly, quarterly and semi-annual billing compliance reviews designed to identify issues early and assist homecare agencies in instituting in-service trainings to field and administrative staff to ensure improvement in following reviews. 

Peace of mind that patient’s needs are being met is no longer assurance that your agency is safe from overly aggressive fraud investigations.  Please visit our blog at www.BrooksAcevedoBlog.com for more information about fraud and abuse.

 

A former employee is stealing patients from my agency. What can I do?

Information Coming Soon.

 

What actions can I take to discipline an employee?

Information Coming Soon

 

HELP, I can’t get paid.  What do I do?

One of the most frustrating and potentially anxiety causing situations for homecare agencies often involves the inability to get paid timely for claims. Payment disputes Medicare, Medicaid and private insurance payors all have varying procedures for processing payments. When something goes wrong these processes become cumbersome and often futile without the help of legal representation to guide an agency throught the contractual language that governs payments to agencies.  Agencies should collect a detail list of all outstanding claims and all correspondence from the payor, a copy of the contract if the payment involves an insurance company, and copies of all clinical records for the dates of service that are unpaid.  Our staff can assist with determining if claim appeals or settlement negatiations are the best course of action as well as assisting in determining how to avoid future disputes. 

Medicare, Medicaid and private insurance all have different procedures and timelines for filing billing disputes.  Brooks*Acevedo offers guidance as well as appeal services so agencies can maximize their potential for positive results.  There are restrictions on providing new documents at many levels of appeals depending on the payor.  Make sure your agency understands the pros and cons of clinical document submission as well as what types of supplemental documentation should be considered prior to appealsing denied claims.

 

What can I do about a ZPIC overpayment notice I just received in the mail?

 

 

 

Brooks Acevedo Attorneys at Law

Defending the rights of health care providers since 2008

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(713) 777-7332


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