With the Medicare Complete Error Charge Trying out program projected error charge for knowledgeable nursing amenities (SNFs) appearing a vital build up in 2022 (15.1%, up from 7.9% in 2021), the Facilities for Medicare and Medicaid Products and services (CMS) has prompt each and every of its Medicare Administrative Contractors (MACs) that overview SNF Medicare claims to start up a five-claim probe and teach scientific overview for each and every SNF within the MAC’s jurisdiction.
CMS surmises that the supply of the rise in unsuitable bills might lie with the trade from useful resource usage staff (RUG) IV to the affected person pushed fee style (PDPM) and has famous that the main root explanation for SNF mistakes is lacking documentation.
MACs are prompt to put in force the five-claim probe on a rolling foundation starting with the highest 20% of SNFs that display very best possibility. If any unsuitable bills are recognized, the MAC will alter (or deny) the declare(s) and be offering both standard training or 1:1 individualized training relying at the error charge. 1:1 training will come with declare explicit knowledge and make allowance the SNF to study the declare resolution, ask questions and obtain comments.
Starting June 5, 2023, SNFs nation-wide must be searching for a prepayment probe and teach file request from the MAC and be ready to reply inside of 45 days. You probably have questions on CMS’ probe and training overview procedure, the Healthcare Crew at Sheppard Mullin is to be had to help.