As with every business, there are myriad laws and administrative rules with which a home health care organization must comply. However, health care is among the most regulated industries and subject to a wide spectrum of regulatory compliance challenges. Whether your organization is a Medicare provider or not makes a difference in your compliance requirements. A few of the most important and often overlooked points of home health care compliance for Medicare certified agencies relate to personnel.
Probably the easiest violation to avoid is determining whether any person who is employed by your organization has been excluded from participation in any Federal health care program -not just Medicare. The exclusion applies regardless of who submits the claims and also applies to all administrative and management services furnished by the excluded person.
The Office of the Inspector General of the Department of Health and Human Services maintains a list of excluded individuals. This list is publicly available at https://exclusions.oig.hhs.gov/ . This exclusions check is well known because it’s a requirement for a home health care organization’s compliance with the Medicare Conditions of Participation and accreditation standards. However, as with any human endeavor, mistakes and lapses in processes happen and this is where one of the main functions of an effective compliance program applies: Conducting internal monitoring and auditing. If your organization reviews personnel files on a regular basis, missed exclusions can be found and addressed. Hiring an individual who has been excluded from participation in any Federal health care program could possibly lead to the hiring entity being excluded, as well. At the very least, unexpected expenses and costly remediation may impede the financial progress of the business.
A second violation that is easily avoided is the verification of professional licenses. The licenses of all physicians and other prescribers of medically related home care services – not just employees or contractors who provide care to an organization’s patients – must be regularly vetted. For example, Medicare guidelines state that the health care organization must not dispatch an unlicensed person to provide care to a patient. Period. While it is unreasonable to check every RN’s license with the state regulatory board every single day, a systematic and periodic review of the license status is not unreasonably burdensome. The important thing to consider is that it’s not enough to only check the RN’s license upon hire or contract; a best practice is to calendar an RN’s licensure expiration date and contact the RN a few weeks prior to determine compliance with licensure renewal requirements. Then, the day before the license expiration, check to determine renewal. If on that day, the license has not been renewed, removing the RN from service is in order until verification of a valid license can be achieved.
Verification of physicians’ and other prescribers’ license status is also a requirement for the home health care organization. Again, one check of the license status is only as good as that day. That individual may have problems shortly thereafter and lose the authority to prescribe home health care or renew plans of care and orders. Since these tasks or services do not happen every day, it is not unreasonably burdensome to check the status of a prescriber’s license at the time of or just prior to the renewal of the POC or when changes are made to physician orders. While compliance with the requirements mentioned above, and the numerous other guidelines, may seem mundane, rote and rarely worth the time, effort and expense, not doing so may cost many times more than implementing and earnestly operating an effective compliance program.