In the restorative and personal care area, the OIG’s Supplemental Compliance Guidance stresses that facilities are expected:
- Avoid pressure ulcers,
- Improve passive range of motion,
- Improve ambulation,
- Fall prevention management,
- Incontinence management, and
- Enhance bathing, dressing and grooming activities.
Failure to provide restorative services, yet submitting claims for such services can create a risk of liability under Fraud and Abuse and False Claim Statutes.
Key strategies for avoiding compliance problems with restorative and personal care services include:
- Engage in resident / staff interviews;
- Consult with attending physicians and medical directors;
- Consult with consulting pharmacists;
- Make personal observation of care provided; and
- Assure complete and contemporaneous documentation of services.
In evaluating your facility’s compliance with this risk area, here are some recommended questions for staff assigned to monitor and assess restorative and personal care services during resident/staff interviews:
- Are residents receiving restorative services?
- What types of restorative services?
- Active/Passive Range of Motion,
- Ambulation, and
- Stationary/In-bed exercises.
- How often are services provided?
- Who provides services?
- Are the services successful?
Always check documentation post-interview to assure consistency.
What is physician involvement in restorative/personal care services?
- Contact physicians periodically to request further instruction on restorative opportunities;
- Explain current services and progress to date;
- Request that additional residents be included in “trials” to determine whether they are appropriate for restorative services;
- Request education/consultation on new or different approaches to restorative services; and
- Document conversations as appropriate.
The monitoring staff/team also should randomly observe services based on input from resident/staff interviews:
- Are services provided as stated?
- Is staff competent to provide needed service?
- Are residents actively participating?
- Do barriers exist that impede active participation?
- Signs of pain,
- Failure by staff to actively engage with resident,
- Lack of equipment, and
- Instances where staff pulled to other tasks.
Documentation of restorative and personal care services also is critically important and the monitoring staff/team should consider the following steps to measure compliance:
- Conduct random/periodic audits of restorative services documentation:
- Base audits on interviews/observations,
- Assure documentation is consistent and contemporaneous with observations,
- Assure that documentation includes progress over time or the basis for discontinuing restorative services, and
- Assure that documentation is sufficient to support payment for services.
Monitoring / Observation
Effective Compliance Programs