Medicare Skilled Nursing Facility Reimbursement and Upcoding

2012 ◽  
Author(s):  
John R. Bowblis ◽  
Christopher Brunt
Keyword(s):  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

Physical Activity Behavior of Skilled Nursing Facility Patients: A 21-day Longitudinal Cohort Study (Preprint)

2020 ◽  
Author(s):  
Wenhao Zhang ◽  
Ramin Ramezani ◽  
Zhuoer Xie ◽  
John Shen ◽  
David Elashoff ◽  
...  
Keyword(s):  
Physical Activity ◽  
Energy Intensity ◽  
Indoor Localization ◽  
Pearson Correlation ◽  
Patent Application ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Longitudinal Changes ◽  
Therapy Room

BACKGROUND The availability of low cost ubiquitous wearable sensors has enabled researchers, in recent years, to collect a large volume of data in various domains including healthcare. The goal has been to harness wearables to further investigate human activity, physiology and functional patterns. As such, on-body sensors have been primarily used in healthcare domain to help predict adverse outcomes such as hospitalizations or fall, thereby enabling clinicians to develop better intervention guidelines and personalized models of care to prevent harmful outcomes. In the previous studies [9,10] and the patent application [11], we introduced a generic framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and extraction of indoor localization using BLE beacons, in concert. This work is to address the longitudinal analyses of a particular cohort using the introduced framework in a skilled nursing facility. OBJECTIVE (a) To observe longitudinal changes of physical activity and indoor localization features of rehabilitation-dwelling patients, (b) to assess if such changes can be used at early stages during the rehabilitation period to discriminate between patients that will be re-hospitalized versus the ones that will be discharged to a community setting and (c) to investigate if the sensor based longitudinal changes can imitate patients changes captured by therapist assessments over the course of rehabilitation. METHODS Pearson correlation was used to compare occupational therapy (OT) and physical therapy (PT) assessments with sensor-based features. Generalized Linear Mixed Model was used to find associations between functional measures with sensor based features. RESULTS Energy intensity at therapy room was positively associated with transfer general (β=0.22;SE=0.08;p<.05). Similarly, sitting energy intensity showed positive association with transfer general (β=0.16;SE=0.07;p<.05). Laying down energy intensity was negatively associated with hygiene grooming (β=-0.27;SE=0.14;p<.05). The interaction of sitting energy intensity with time (β=-0.13;SE=.06;p<.05) was associated with toileting general. Dressing lower body was strongly correlated with overall energy intensity (r = 0.66), standing energy intensity (r = 0.61), and laying down energy intensity (r = 0.72) on the first clinical assessment session. CONCLUSIONS This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features, a subset of which can provide crucial information on the storyline of daily and longitudinal activity patterns of rehabilitation-dwelling patients.

Termination of Skilled Nursing Facility Medicaid Provider Agreements: Procedural Due Process Requirements

1981 ◽  
Vol 6 (4) ◽  
pp. 451-493
Author(s):  
Nancy Elizabeth Jones
Keyword(s):  
Due Process ◽  
Skilled Nursing Facility ◽  
Health And Safety ◽  
The State ◽  
Federal Regulations ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Medicaid Reimbursement ◽  
Emergency Situations ◽  
Procedural Due Process

AbstractWhen a state Medicaid agency terminates its provider agreement with a skilled nursing facility, federal regulations give the state the option of providing a pretermination evidentiary hearing; they do not, however, require that a state provide such a hearing. If a state chooses not to grant a pretermination hearing, as a number of states have done, federal regulations require: (1) an informal written reconsideration made by the state and submitted to the skilled nursing facility before the effective date of the termination, and (2) a posttermination evidentiary hearing.This Article argues that a skilled nursing facility has a right under the due process clauses of the fifth and fourteenth amendments of the U. S. Constitution to an evidentiary hearing before termination of its Medicaid provider agreement. The author claims that a skilled nursing facility's interest in continued receipt of Medicaid reimbursement under its provider agreement is a property interest entitled to constitutional due process protections, and not merely an expectation of economic benefit that does not implicate constitutional due process considerations.The Article concludes that, except in emergency situations, state Medicaid agencies are constitutionally required to grant a provider a pretermination, rather than a posttermination, evidentiary hearing. This procedure would protect the provider and its patients from the severe effects of an erroneous termination, while furthering the governmental interest in ensuring the health and safety of skilled nursing facility patients. The format for such a hearing should allow for the participation, with the assistance of counsel, of both the skilled nursing facility and its patients.

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