Excelas LLC - Medical, Legal, Solutions

Medical expertise for healthcare defense:
claims, litigation, compliance


Is Your Facility Too Lenient on Physician Certifications?

by ExcelasJanuary 26, 2018
Problems with documentation in skilled nursing facilities (SNF) often lead to claim denials that can negatively impact cash flow and make these facilities susceptible to audits. According to findings in the 2017 Comprehensive Error Rate Testing report, one of the most common errors in medical reviews is missing or insufficient physician certification and/or recertification statements. [More]

Long-term Care | Medical Review | Regulatory

CMS Extends Moratorium on Phase 2 Enforcement Penalties

by ExcelasJanuary 26, 2018
In November, the Centers for Medicare and Medicaid Services (CMS) announced it would give SNFs more time to adjust to some of the regulatory changes in LTC requirements before being penalized. Previously, the agency said it would restrict enforcement for one year, but due to readiness concerns from long-term care providers, they have extended their moratorium on penalties to 18 months.[More]

Long-term Care | Regulatory

3 Ways to Improve Your Billing Process and Avoid Recovery Audits

by ExcelasJuly 6, 2017
Recovery auditors typically look for discrepancies in the nursing facility’s reimbursement requests. And while recovery audit decisions are generally appealable, it’s better to avoid an audit than to appeal one. Fortunately, there are a few proactive steps to take prior to finalizing billing that may help avoid audits—or allow a facility to successfully weather closer scrutiny. [More]

Issues in LTC | Medical Records | Regulatory

Are Kennedy Terminal Ulcers Gaining Recognition Among Federal Regulators?

by ExcelasAugust 7, 2013
Long-term care (LTC) providers have, for years, asserted that not all skin alterations are an indication of poor-quality care.  The Kennedy Terminal Ulcer (KTU) was originally noted more than a century ago, and was formally studied for the first time in the 1980s.  But it has taken until now for federal regulators to give any credence to the phenomenon—and specifically, to consider excluding this particular type of ulcer from among the list of quality indicators. A recent draft of Long Term Care Hospitals Quality Reporting Program Manual, a Centers for Medicare & Medicaid Services (CMS} publication released in April 2013, appears to recognize Kennedy ulcers as an issue separate from quality of care, instructing providers not to report them on quality reporting tools once they have been confirmed.    CMS’s recognition of this issue seems to currently extend only to Long-Term Care Hospitals (LTCHs), and not to other types of facilities where KTUs are likely to be found—in particular, skilled nursing facilities (SNFs) where the majority of elderly in poor health spend their final days and weeks.  Still, this is a positive step forward for long-term care providers that hopefully won’t stop with the LTCHs or long-term acute care facilities.  It’s possible CMS will extend this recognition to SNFs, hospices, and other facilities providing end-of-life care. Pressure ulcers, in general, have been a hot button in LTC claims and litigation for years.  Plaintiffs frequently use ulcers as the epitomizing physical manifestation of poor care or negligence.  But as practitioners know—and as CMS seems to be acknowledging—the quality of care provided is not always at issue.  In the case of Kennedy ulcers, poor care is never the direct cause.   Continuing an open dialogue about Kennedy ulcers is critical for improving understanding of the end of life process.  As practitioners and regulators become more knowledgeable about these ulcers, families of afflicted loved ones will also become better informed.  When Kennedy ulcers are well understood as a symptom of end-of-life organ failure, not as evidence of neglect, it may help alleviate some of the shock and hurt experienced by family members, and some of the stigma and risk experienced by healthcare providers.   To learn more about how to defend against claims related to infection control, talk to an expert at Excelas. To learn more about how to defend against claims regarding Kennedy ulcers talk to an expert at Excelas. To learn more about how to defend against claims related to infection control, talk to an expert at Excelas.

Issues in LTC | Long-term Care | Regulatory

The List of Monitored Atypical Antipsychotic Drugs Just Got Longer

by ExcelasMay 31, 2013
The use of atypical antipsychotics in elderly nursing home residents with dementia continues to be a hot topic for CMS. Newly updated guidelines offer more guidance and criteria for when the drugs can appropriately be prescribed [More]

Long-term Care | Regulatory

© Copyright 2014 Excelas, LLC all rights reserved. Terms of Use | Privacy Policy