1. Specifically target and identify what you are monitoring.
a. Task: audit and monitor the following aspects of the facility’s program(s) to evaluate any reserved bed arrangements in terms of compliance with federal Anti-Kickback Statute limitations and the Medicare Provider Reimbursement Manual:
- Do we utilize reserved bed arrangements with any local hospital?
- If so, are these agreements committed to writing so we can ensure they are consistent with the provisions of the PRM and the OIG’s Supplemental Guidance on such agreements?
- Do we have in place a policy or procedure that defines the limits or parameters of any reserved bed arrangements we are willing to utilize or are currently utilizing and are such policies/procedures consistent with the OIG’s statements on such agreements and with the PRM (you may use the summary above to develop such a policy/procedure and then to measure your facility’s compliance against)?
- Do we ensure that any bed reservation agreements are reviewed by legal counsel for compliance with the PRM and applicable law/guidance on the federal Anti-Kickback Statute?
- Do we periodically (at least annually) review the actual implementation of any reserved bed arrangements to ensure consistency in practice (not just in contract terms) with those authorities?
- Do we modify our policy/procedure on reserved bed arrangements and our actual implementation of them where we find variances between them and the PRM and/or the OIG’s statements regarding the federal Anti-Kickback Statute and reserved bed arrangements
2. Design the specific steps that will make up the monitoring process for the particular issue you are auditing.
a. Review applicable policies and procedures addressing the issue of reserved bed arrangements.
b. Review existing contracts covering reserved bed arrangements.
c. Review our actual implementation of any reserved bed arrangements in terms of the hospital’s demonstrated need for reserved or priority beds, the amount, type and frequency of items of value flowing in either direction under such arrangements.
d. Regarding any such arrangements the involve in-kind services, are these services made available to all residents of the facility and not just during periods when the reserved beds are occupied or for residents residing in reserved beds?
e. Interview hospital and facility staff responsible for negotiating reserved bed arrangements and for actually implementing them to ensure both aspects of these agreements (the contract terms and the implementation) are consistent with our policies on these arrangements.
3. Decide how your company or facility will use the information obtained as a result of auditing and monitoring.
a. The results of the above inquiries will be provided on a regular basis to facility administration and the facility’s quality assurance committee for discussion and revision as needed, with appropriate training or re-training as indicated.
b. Applicable policies and procedures on reserved bed arrangements will be revised as needed to reflect the OIG’s guidance on such agreements and the provisions of the PRM. Repeat and update the training of staff responsible for executing and implementing such arrangements, as appropriate to respond to identified failures in existing policies/procedures and practice.
c. As appropriate, the Compliance Officer will discuss the results of such audits with senior management and/or the Board of Directors (or owners) and determine whether any additional measures are required or recommended, whether additional compliance safeguards should be instituted at the facility (including more frequent auditing of applicable procedures), whether training of employees and/or contractors is recommended and such other corrective and monitoring activities are appropriate.