Texas OIG inspectors recently reviewed payroll records from a skilled nursing facility to determine if the hours of direct care provided by licensed nursing staff were accurately reported. During the inspection, it was determined that the facility had accurately reported hours worked on 88 percent of the 514 records under review. However, there was a concern that the facility did not have documented processes for reporting complete and accurate direct care licensed nursing hours to the Centers for Medicare & Medicaid Services (CMS) through the Payroll-Based Journal reporting system. As a result, the facility:
- Overreported and underreported some direct care licensed nursing hours worked
- Inconsistently accounted for required meal break deductions
Additionally, the facility did not consistently maintain complete payroll records to document all direct care licensed nursing hours worked or the number of direct care hours worked by administrative staff.
To assist with their reporting requirements, the facility utilizes an electronic timekeeping system that uses fingerprint scans to account for patient hours. By default, this program utilizes a time rounding guideline known as the seven-minute rule, which rounds staff time to 15-minute increments. For example, if a staff member clocks in at 7:07 a.m., the program rounds the time down to 7:00 a.m., and if a staff member clocks out at 4:55 p.m., the time is rounded up to 5:00 p.m.
Due to an inconsistent application of the seven-minute rule, OIG inspectors could not definitively quantify the number of direct care hours overreported and underreported within the provided documents. Facility management provided multiple methodologies for how the seven-minute rule was applied, but all of the methods resulted in errors.
Additionally, the facility provided a small number of payroll records that had missing staff time entries or did not identify the direct care hours provided by licensed staff whose primary current role at the facility was administrative. As a result, OIG Inspections could not verify the accuracy of 20 out of 512 submitted payroll records or compare them to payroll records submitted to CMS.
OIG inspectors provided recommendations to assist the facility in addressing these areas of concern, which facility management indicate have already been implemented.
Compliance Perspective
Issue
Nursing facilities must electronically submit payroll data to CMS through a web-based platform that documents payroll data. This submission includes each direct care staff member’s category of work, hours of care provided by each category of staff, full resident census data, and staff turnover and tenure information, including hours worked and length of employment. The data, when combined with census information, can then be used to report on the level of staffing in each nursing home, as well as employee turnover and tenure, which can impact the quality of care delivered.
Discussion Points
- Review policies and procedures on maintaining daily nurse staffing data and documentation of direct care hours. Update your policies as needed.
- Train appropriate staff to accurately document and report direct care hours worked. Direct care hours worked by administrative staff should be documented in the payroll records before reporting licensed nursing hours to CMS through the Payroll-Based Journal. Document that these trainings occurred and file in each appropriate employee’s education file.
- Periodically audit to ensure that direct care hours worked are accurately reported to the Payroll-Based Journal as required by CMS. Also audit to ensure payroll records are complete and all information is correct. Observe to ensure that F732 Nurse Staffing Information Posting Requirements in the State Operations Manual Appendix PP is followed and includes daily posting of all required information in a clear and readable format and is located in a prominent place readily accessible to residents and visitors.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
