Rehab claims scrutinized, expert warns

Share this article:
Nursing home administrators who can't back up every minute of rehab therapy delivered in their building leave themselves open to auditing, an MDS 3.0 expert says.

Every skilled nursing facility billing minutes to rehab services must be able to verify that he or she has read all of the updates to the RAI Manual, as well as all of the changes that took effect April 1, Leah Klusch, RN, BSN, FACHA, cautioned listeners during a McKnight's Super Tuesday webcast in July. 

The Centers for Medicare & Medicaid Services is very focused on Medicare Part A fraud right now, Klusch warned. Medicare's Zone Program Integrity Contractors (ZPICs) in particular are looking closely at rehab claims.

“It's not someone taking a casual look at your data,” Klusch said. “An audit means there is some suspicion of Medicare abuse or Medicare fraud. These audits have been very caustic so far.”

But Klusch also said not everything is gloom and doom for skilled nursing facility operators. The Affordable Care Act has opportunities for SNFs, such as joining accountable care organizations, to lower costs and reduce hospital admissions, she said.
Share this article:

More in News

Breier named new CEO at Kindred

Breier named new CEO at Kindred

Kindred Healthcare announced Thursday that it has chosen a new top executive to lead its push toward creating a mammoth national brand. Benjamin A. Breier, the company's current president and ...

Proposed managed care rule could accelerate shift away from nursing home care, official suggests

Proposed managed care rule could accelerate shift away ...

Proposed regulations slated for early 2015 likely will affect how Medicaid managed care balances home- versus facility-based long-term care, news sources reported Wednesday.

Assisted living residents say 'homelike' setting not so important

Contrary to conventional wisdom, assisted living residents might not place a high value on how "homelike" their surroundings are, suggest findings out of St. Catherine University in St. Paul, MN.