CMS widens audits, hones in on Part A claims, expert says

Share this article:
Resident assessments and care planning quality are threatened by nurses' unrelated duties, survey fi
Resident assessments and care planning quality are threatened by nurses' unrelated duties, survey fi

The Centers for Medicare & Medicaid Services has increased its scrutiny of Medicare Part A filings recently and as a result, has reclaimed more funds than ever from providers, a long-term care compliance expert noted at a recent McKnight's Super Tuesday webcast.

Providers must therefore intensify their efforts to be compliant, said Leah Klusch, executive director of the Alliance Training Center and the featured speaker at McKnight's May 7 webcast.

“CMS is serious about this. They're returning significant amounts of payments to the program due to issues with compliance and documentation processes,” Klusch said. “You have to be just as serious. The rules are not rocket science. You need to make sure the MDSes and bills match, and people delivering care know definitions.”

More than 500 providers will face increased oversight through the new ZPIC audit system, Klusch explained. New computer technology with a sophisticated analytical program makes it possible.

Klusch advocated better technology for providers as well. She said “scrubbers” that generate electronic comparisons of Minimum Data Set and billing data to ensure consistent data are helpful, because identifying these discrepancies in the federal database between billing and the clinical record has been “fairly easy” for auditors. 

Klusch cautioned webcast attendees that inconsistencies in fields such as admission diagnosis and types of service can lead to “intense audit activity.”

Using a computer program to check for consistency is preferable to a triple-check manual process, she believes. 

The full webcast is available for viewing in archive at www.mcknights.com/expo2013.

Share this article:
close

Next Article in News

More in News

'Minor' issues at the nursing home can cause disastrous care transitions, expert warns

'Minor' issues at the nursing home can cause ...

What may appear to be minor administrative problems in a nursing home - a fax machine locked away at night or no one designated to copy paperwork - can cause ...

Long-term care facilities approach 80% worker flu vaccination rate after handing power ...

Fourteen long-term care facilities in Pennsylvania dramatically increased their staff flu vaccination rate by having a regional pharmacy take over the process, according to a report issued Thursday by the Agency for Healthcare Quality and Research (AHQR).

RACs were 'most improved' healthcare auditors for getting back money in 2013, ...

Medicare Recovery Audit Contractors dramatically stepped up their overpayment recoveries last year, returning nearly $487 million more to the government than they did in 2012, according to a new report from a federal watchdog agency.