SNF rehab claims scrutinized more than ever, expert says

Leah Klusch, RN, BSN, FACHCA

Nursing home administrators who can't substantiate every minute of rehab therapy delivered in their building leave themselves open to increasingly common audits and surveys, a leading MDS 3.0 expert said Tuesday.

Every skilled nursing facility employee who bills 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, top educator Leah Klusch, RN, BSN, FACHA, cautioned listeners during a McKnight's Super Tuesday webcast.

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

“It's not someone taking a casual look at your data,” Klusch said of ZPIC auditors. “An audit means there is some suspicion of Medicare abuse or Medicare fraud. Administrators need to make sure their therapy person knows exactly ‘who's on first.' These audits have been very caustic so far.”

But Klusch also told webinar participants that not everything is gloom and doom for skilled nursing facility operators. The Affordable Care Act has created opportunities for SNFs to lower costs and reduce hospital admissions, she explained.

“Accountable care organizations are being formed …  if one is forming in your area, get involved. It's extremely important,” she encouraged.