Informal Dispute Resolution, I guess some review is better than none.
Posted by: Robert Markette
May 19, 2006

As many of you are aware, home care and hospice providers have no right to an administrative appeal of the results of a survey.  This means that when you receive a survey report, you are left with two options, provide a plan of correction, even for things you don?t think are wrong, or do nothing and argue your disputes during the appeal of your license revocation or decertification.  In Indiana, and some other states, you have a third option, Informal Dispute Resolution, but those of you who know me know that I am not a big fan of it.  (Primarily, because I believe you should be able to appeal a survey report to an Administrative Law Judge or ALJ.)

Informal Dispute Resolution, or IDR, gives you an opportunity to dispute the survey results, but it should never be mistaken for a hearing before a disinterested third party.  You are simply taking your objections to the surveyor?s supervisors, who may be willing to listen, but who are not disinterested third parties. In an IDR, the surveyed agency is able to either submit documentation or meet face to face with the Indiana State Department of Health (?ISDH?) to try to refute the findings.  The agency meets with three of the supervisory officials and has around one hour to explain why the survey report is mistaken.

Given that this is not a review by a disinterested third party, that there are little procedural rights, that nothing in the report may change, that the survey agency reserves the right to add findings, and that the reviewer is basically the surveyor?s supervisors many agencies forego the IDR process without really considering it.  

Although I would prefer an actual appeal, some opportunity to be heard is better than no opportunity.  Frankly, an IDR can be valuable for a number of reasons.  First, the IDR may result in the removal of a few tags.  Yes, it is even possible to have a tag removed.  This potential alone makes it worth the effort.  Although the removed tag may not completely resolve the agencies issue, at least you have fewer things to worry about fixing.  It does not happen all the time, but some chance is better than no chance.  

Another important aspect is the chance to get a clearer picture from the survey agency as to what they saw was the problem.  Often, during the course of an IDR, the survey agency?s statements and questions will provide clarification as to the issues.  This can give you a much better idea how to correct things so that the resurvey goes more smoothly.   Occasionally, the IDR panel will simply state why they wanted to see during the survey.  This clarification alone is well worth the time spent preparing for the IDR.

Finally, the IDR at least gives you the chance to make a record before the agency of your dispute.  It may not be much, but at least you have made your case to the agency as to why you think they are incorrect.  Until the courts and legislators recognize the harm inherent in an inaccurate survey report and grant that due process requires some right to review, you should at least consider the IDR process, instead of dismissing it as a complete waste.
 

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Deadlines for filing responses to CMS requests. (Originally Posted October 27, 2005)
Posted by: Robert Markette
December 12, 2005

In a recent PRRB decision, Saddleback Memorial Medical Center Laguna Hills California v. BlueCross BlueShield Association/ United Government Services, LLC-CA, Case No. 99-2472, September 29, 2005, the PRRB confirmed that when counting days for determining a deadline to respond to a request for additional information from CMS, you should begin counting with the day after you receive the request.  The PRRB also confirmed that if after counting the number of days to the deadline you determine the deadline is on a weekend, then the deadline automatically extends to the first business day after the weekend. 

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