Medicare audits ‘ramping up’ with isolation coding in the crosshairs
By
Josh Henreckson
Apr 22, 2024
Auditors are paying special attention to isolation and quarantine coding amid already heightened Medicare nursing home audits that are expected to increase in coming months, experts warn.
Three questions to boost nursing home audit readiness
By
Brian Evans
Sep 20, 2023
Nursing home and long-term care operators have already faced a number of key shifts since the beginning of 2023. Consider a recent example from the Centers for Medicare & Medicaid Services: an update on...
Claims audit will affect every nursing home starting June 5
By
Kimberly Marselas
May 30, 2023
Every skilled nursing facility in the US will be subject to a five-claim audit starting the week of June 5 as regulators try to better assess and root out improper payments.
Flurry of Medicare Advantage regulation likely to hit nursing home coffers
By
Kimberly Marselas
Feb 03, 2023
Federal efforts to rein in Medicare Advantage spending and recoup payments awarded for improper diagnoses will likely lead to even more financial pressure on nursing homes that serve plan beneficiaries,...
CMS to begin audits for schizophrenia coding, says citations will affect quality ratings
By
Alicia Lasek
Jan 19, 2023
The agency will start auditing nursing homes this month to determine whether residents’ schizophrenia diagnoses are accurate and appropriately coded. A pattern of inaccurate coding may result in a quality...
Stricter audits may be on the horizon from the OIG
By
Norris Cunningham
Kennedy Bunch
Devin Zimmerman
Jan 11, 2023
Long-term care facilities and providers should brace themselves for what may be an uptick in enforcement activity from Medicaid Fraud Control Units (MFCUs) in the coming year. In 2023, the U.S. Department...
After record penalties, providers can protect themselves from the DOJ with 3 priorities, experts say
By
Joe Bush
Nov 28, 2022
The Department of Justice is on pace to hand out a record $5.6 billion-plus in total fines and penalties under the False Claims Act this year, a clear indicator that the agency has removed the kid gloves...
Providers warned: Ongoing relief fund audits may bring unprecedented info demands
By
Joe Bush
Nov 21, 2022
Provider Relief Fund audits have started in earnest, with the threat of federal investigators demanding more and different data than most skilled nursing providers have ever been asked to account for.
Headed for the Provider Relief Fund reporting portal? Consider these tips first.
By
Kimberly Marselas
Jul 20, 2021
Confusion and uncertainty are clouding the landscape as nursing homes across the country begin reporting lost revenues and COVID-19 related expenses that would allow them to keep their share of federal...
Spring cleaning 2021: Will your rehab team pass the white-glove review?
By
Renee Kinder
Apr 22, 2021
Spring is in the air. Time to open the doors, let some fresh air in, and clean above, under and between every surface in our homes. Spring is a season that allows my obsessive cleaning habits to become...