Q:
Our facility has been issued a Denial of Payment for new admissions due to survey deficiencies. Should we continue to submit the MDS for current and newly admitted residents?
A:
A Denial of Payment for new admissions (DPNA) is a CMS enforcement remedy that might be imposed for deficiencies cited at a facility. A mandatory denial of payment for new admissions must be imposed when the facility is not in substantial compliance three months after the last day of the survey identifying deficiencies, or when a facility has been found to have furnished substandard quality of care on the last three consecutive standard surveys. It can also be imposed for Immediate Jeopardy deficiencies depending on the circumstances and the number of residents involved. DPNA means the facility will not be paid any government funds billed for residents who are/were admitted after the date of notice of the Denial of Payment. It does not affect private insurance or private pay residents.
In the letter that accompanies the Statement of Deficiencies (SOD – 2567) information will be included that describes that the DPNA will be imposed, along with the date of the notice. All government funds will cease to be paid beginning with the date of notice, and continuing until the date the facility is determined by the Survey Agency to be back in substantial compliance. It is at the facility’s discretion whether or not they want to continue admitting new residents after the date of notice. The DPNA does not require the facility to stop taking new admissions but rather mandates that there will be no payment for these newly admitted residents until the facility is determined to be back in compliance. For residents who were already residing in the facility prior to the date of notice but were admitted to a hospital and then later returned after the date of notice, the facility will be paid for their submitted bills as they are not considered new admissions.
If the facility makes the decision to continue new admissions after the date of notice, it must recognize that payments for these residents will not begin until they have corrected the identified deficiencies and had a survey revisit that determined it is back in substantial compliance. The payments will be re-initiated beginning the date the Survey Agency established the facility was back in substantial compliance and billing has been submitted. Any new or repeated deficiencies identified could prevent the facility from achieving substantial compliance, depending on the scope and severity of the deficiencies.
The MDS assessments for all residents during the period of Denial of Payment must continue to be completed timely in accordance with the RAI requirements. Not only could failure to complete the assessments result in a deficiency which might prevent substantial compliance, but the MDS assessments will be needed for billing that can be submitted as soon as the facility compliance date is established. Entry tracking, Admission and Medicare 5-day assessments must still be completed for all newly admitted residents, even those that may be impacted by the DPNA. All other types of MDS Assessments required after new admission must also be completed as per the RAI requirements for all residents, whether or not they are included under the DPNA imposition. The facility must make every effort to correct the deficiencies and monitor ongoing compliance as quicky as possible to stop the DPNA in the shortest amount of time that can be achieved.
Written By:
Janine Lehman, RN, RAC-CT, CLNC
Director of Legal Nurse Consulting
Proactive LTC Consulting
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