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

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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.

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