Rehab claims scrutinized, expert warns

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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.
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