Typically, I get the Friday Feature posts out early enough on a Friday for folk to read before a longer weekend or leaving the office early. Working today with my wife on an SNF/Hospice litigation matter got me behind but the same did form today’s Feature.
My wife’s practice and our firm are seeing more litigation cases involving multiple parties. For example, Assisted Living and Home Health, SNF and Hospice, Assisted Living and Hospice, etc. What these cases typically involve is a negative outcome to the patient and/or resident and then, a back-and-forth of who was responsible for level of care and level of engagement. Suffice to say, by law and regulation, there are some pretty bright lines in these relationships yet, providers seem to consistently blur the lines. In other words, all too often, what should be clear in these relationships is not because both parties failed to clearly denote “who was responsible for what” in terms of the care of the resident/patient.
When requisite clarity lacks and each party is less than clear as to respective responsibilities, a number of issues can arise for each party, not including potential litigation risk.
- Compliance and billing risk. The potential is created for documentation flaws, inappropriate claims for services which may not be properly documented, or duplicative, etc.
- Survey and certification risk. We see this mostly with hospices and SNF where both provider Conditions of Participation have specific requirements when a SNF resident becomes a hospice patient within the SNF.
- Financial risks or financial losses whereby the parties fail to understand who is responsible for paying for what. Again, this is all too common with assisted livings and SNFs and hospices. I’ve seen way too many times where the SNF is paying for DME, eating medication costs, supplements, transportation, other tests that should be paid for by the hospice. This can be very costly for a Medicaid patient in a SNF.
- And, finally, litigation risk. This typically occurs when the communication and requisite education duties are poor or dropped by both parties and residents/patients and then their estates, believe that litigation is the only way they can get satisfaction and an explanation for responsibility and accountability for a bad outcome. In a separate post upcoming, I’ll delve more into prevention/risk reduction tips associated with bad outcomes and multiple party/provider involvement.
So, for today’s feature, I’ve pulled forward content from an oldie but a goodie post I wrote on Hospices and SNF relationships, duties, etc. It is as applicable today as it ever was. TGIF! The link to the post is below.
Hospice Contract Reminders for SNFs