Every morning when I walk into my office, the first thing I do is say The Carmelina Pledge for Long Term Care.  I say it because I have a passion for the elderly. It’s that simple.

There are times though through the course of my day when things get tough, and I need to say this pledge out loud again.  This is especially when faced with news articles about therapy payment reform, Medicare abuse, documentation audits, SNF payment cuts, etc.

Our current environment exhibits an increase in government audits. There is also the profound burden of the ever changing rules and regulations from CMS.  Insurance companies are being seen as a contender in the auditing arena.  Improper payments are becoming more and more evident as the result of government audits.  Is it because providers are doing something wrong?

Ensuring an internal auditing plan and taking control of your auditing process is vital to the sustainability of your financials. The importance of documenting quality management, policy and procedure compliance, internal auditing practices, and education/training, is crucial to be free from resource and cost burden of the appeals process.  Compliance resource overhead is one department that generally doesn’t seek enhancement. However, without having a robust compliance department leading the pack, you may be set up for failure.  Therefore, those companies who invest in an active compliance program will experience a decrease in financial risks when faced with government audits.

So, while Uncle Sam is tightening the reimbursement belt, we have to remember the ‘Carmelinas’ in our SNF world.  It is because of them, we find fulfillment.

“I solemnly pledge to live my life with integrity and to practice my profession authentically.  With dedication, and as a steward of the greatest generation’s quality of life, I will endeavor to uphold and elevate the ethical, scientific, and legal standards of my profession, and devote myself to the well being of elders entrusted in my care.”

——–Frosini Rubertino, Author

To learn more about Carmelina, click here.

Gina Tomcsik

Director of Compliance