Administrators must prepare for 'surveyor mentality' of Medicare auditors, expert warns

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Patricia Boyer, MSN, NHA, RN
Patricia Boyer, MSN, NHA, RN

Skilled nursing facility administrators must have greater proficiency in producing therapy documentation to survive increased scrutiny from auditors, a payment expert warned at a McKnight's Super Tuesday session Tuesday.

Any provider that bills Medicare fee-for-service programs is facing higher scrutiny from recovery audit contractors (RACs) and Zone Program Integrity Contractors (ZPICs), which are responsible for detecting improper payments, payment expert Patricia Boyer, MSM, RN, NHA said.

ZPICs have replaced Program Safeguard Contractors and are intended to ensure the integrity of Medicare-related claims, she explained.

“Once they walk in the door of your facility, they already know a lot about you,” Boyer said. “They come in with surveyor mentality feeling like they're there to validate what they already know. It's your job to prove them wrong.”

To prepare for this increased regulatory scrutiny, facility administrators should conduct internal Medicare audits annually — and they must be willing to hire outside consultants for help in doing so.

Administrators also should take responsibility for how therapy is handled in their facility.

“I often ask managers ‘How many times do you go into your facility's rehab gym and watch what's happening? Do you have enough therapists to care for the residents are in there? Are you truly providing individual therapy?'”

The next McKnight's Super Tuesday session will be Tuesday, July 10 with regulatory expert Leah Klusch.

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