Check out this Q&A with Steven Littlehale, executive vice president and chief clinical officer with PointRight, Inc., in Lexington, Mass., about the importance of verifying MDS data and ways that SNFs can improve their MDS data quality.
The use of observation status has long been a sticking point for billing departments in both hospitals and LTC facilities. Many people in the LTC industry can attest to the problems this billing designation has caused, particularly for beneficiaries that require care from a SNF following their hospital stay. Since observation stays do not count toward the Medicare Part A qualifying stay, beneficiaries are often saddled with a sizable bill-sometimes up to tens of thousands of dollars-when they find out they have not qualified for SNF coverage.
Another report was released by the OIG in September, and once again the OIG focused on fraud and abuse. It specifically called out CMS for failing to take timely action on Recovery Audit Contractor (RAC) referrals, as well as a general lack of oversight of the RAC program, especially in developing performance evaluation and improvement metrics to improve RAC performance.