Q: What’s the biggest area that auditors are zeroing in on?
A: Recovery audit contractors and Zone Program Integrity Contractors are really looking at therapy documentation. ZPICs have arrived in the long-term care industry, and once they walk in the door to your facility they already know a lot about you. The more you know about your facility, the less you risk.
Q: How can providers prepare?
A: They need to start by doing an internal audit. It’s always better if you identify your problems before a government agency does it for you.
Q: If a provider hasn’t had success with appeals recently, what do you recommend?
A: You really need to get assistance for the appeals process. The biggest change was when the MDS started being matched to the claim. Now, for instance, if you have an MDS coded where it says the person speaks fine and you’re billing for speech therapy, that could come under scrutiny.
Q: What is the most frightening funding challenge facing operators?
A: You think you’ve been doing things the right way and then find out that you weren’t. It’s important to know what the rules are, monitor what is happening and get assistance when you need it.