• Physician Delegation of Tasks in Skilled Nursing Facilities and Nursing Facilities

    Friday May 17, 2013

    The Centers for Medicare & Medicaid Services (CMS) is publishing this article to provide clarification of Federal guidance regarding Section 3108 of the Affordable Care Act (ACA), related to physician delegation of certain tasks in SNFs and NFs to NPPs (NPPs are formerly "physician extenders") such as nurse practitioners (NPs), physician assistants (PAs), or clinical nurse specialists (CNSs).


    This article addresses the authority of NPs, Pas, or CNSs to perform certain tasks such as conducting physician visits and writing orders, and to sign certifications and re-certifications.

    Physician Delegation

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  • Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs, Issued May 8, 2013

    Wednesday May 8, 2013

    This updated Special Advisory Bulletin describes the scope and effect of the legal prohibition on payment by Federal health care programs for items or services furnished (1) by an excluded person or (2) at the medical direction or on the prescription of an excluded person. For purposes of Office of Inspector General (OIG) exclusion, payment by a Federal health care program includes amounts based on a cost report, fee schedule, prospective payment system, capitated rate, or other payment methodology. It describes how exclusions can be violated and the administrative sanctions OIG can pursue against those who have violated an exclusion. The updated Bulletin provides guidance to the health care industry on the scope and frequency of screening employees and contractors to determine whether they are excluded persons.


    OIG Exclusion from Participation

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  • Is It Time to Renew Your Medical Director Agreement?

    Friday May 17, 2013

    In an arbitration ruling in December 2011 in case of The Estate of Jane Doe versus ABC Health & Rehabilitation Center the terms specified in the Medical Director Agreement played a significant role in the Arbitration Panel ruling in favor of the defendant ABC Health and Rehab.  The Arbitration Panel members found there had been no showing that any act or omission by the nurses at ABC Health and Rehabilitation Center constituted a breach of the applicable standard of care or caused the medical problems culminating in the resident's death.   A significant factor in the favorable outcome of this case for the facility was the terms of the Medical Director Agreement.  The Medical Director Agreement stated that the Medical Director was an independent contractor; the roles of the medical director were clearly stated and did not include a responsibility to diagnose or treat patients.  Rather, the agreement clearly stipulated that any services the physician was to provide in that regard were to be in his independent role as an attending physician and the facility was not liable for the acts or omissions of the attending physician. 


    Are the roles of your Medical Director in your Medical Director Agreement clearly defined and separate from any acts he/she may engage is as attending physician who has a responsibility to diagnose and treat patients?  If not you may wish to review your contract with your corporate counsel and decide if clarification is needed to this area or any other areas of the agreement.


    A sample Medical Director Agreement for your review is available from the American Medical Director Association at the link below. We do not recommend any changes to your agreement without review and discussion with your corporate counsel. 



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  • Corporate Compliance and Ethics Program Requirement

    Thursday May 30, 2013

    The Patient Protection and Affordable Care Act (PPACA) required all Medicare/Medicaid Skilled Nursing Facilities to have an effective Compliance and Ethics Program in place by March 23, 2013.


    The primary purpose of the Compliance and Ethics Program is to prevent, detect, and correct any fraud, abuse, or waste, to promote quality of care, and to have an operational Compliance and Ethics Program in place to meet applicable federal, state, and local laws and regulations. In order to avoid potential exposure nursing facility providers should take steps to implement the required Compliance and Ethics Program.


    Robinson Adams - Arthur J. Gallagher has partnered with Associated Long Term Care Insurance Company, Johnston Barton Proctor & Rose and Care2Learn to assist you with the development of your Compliance and Ethics Program and training along with answering any questions you may have concerning this program.  


    Information from Johnston Barton Proctor & Rose on how they can help you develop your Corporate Compliance Program:


                  Long Term Care - Corporate Compliance Management

                                  Johnston Barton Proctor & Rose


    Our law firm, in partnership with Robinson Adams - Arthur J. Gallagher, has developed a Corporate Compliance Program Template (the "Template") to assist long term care facilities in meeting this requirement.


    Our Template includes a corporate compliance program, employee manual, copies of the applicable statutes  and  regulations,  in-service  log  and  instructions,  corporate  compliance  hotline  information,  and corporate  compliance  log and instructions.  The charge for the Template is $500.00.  Our law firm is also available to assist you with customizing and implementing the Template for your facility at a discounted rate.


    If your facility is interested in purchasing the Template or if our firm can provide your facility with any other assistance in meeting the compliance program requirements of PPACA,  please call Angie Cameron at (205) 458-9489.




    You may also contact Stu DeVust at Care2Learn at 941-465-4578 to find out how you can enroll in the following Corporate Compliance Online Courses:

    1. Corporate Compliance - What You Need to Know (USS-11600)  

    2. Corporate Compliance - What You Need to Know for Assisted Living (USS-11600A)      

    3. Corporate Compliance and the Deficit Reduction Act for Management (USS-11200)     


    Please contact Russ Crouch at 205-414-1390, or our vendor partners, if you need additional information or assistance.

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