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

Long-term care continues to lead in deal volume and value: PwC report

Long-term care continues to lead in deal volume ...

Long-term care bucked healthcare industry trends with strong merger and acquisition activity in the second quarter of 2014, according to newly released data from professional services firm PricewaterhouseCoopers.

Empowering nurse practitioners could reduce hospitalizations from SNFs, study finds

Granting more authority to nurse practitioners is associated with reduced hospitalization of skilled nursing facility residents, according to recently published findings.

Pioneer ACO drops out of program, despite reductions in skilled nursing utilization

A California healthcare system has become the latest dropout from the Pioneer Accountable Care Organization program, despite reducing skilled nursing facility utilization and improving its readmission rates. Sharp HealthCare announced its decision in a quarterly financial statement released Tuesday.