In the months leading to the New Year, much was left to be desired for long-term healthcare providers: Namely, answers. Beginning with anticipation over how CMS’ revision overhaul of Conditions of Participation (CoP) for Medicare will play out during Phase 1 (and 2, and 3) of the new survey process, and ending with scattered talk among the Trump administration of “repeal and replace” of ACA, providers have been anticipating the last straw.
The interplay of Medicare billing and fraud seems like a perennial hot spot among SNFs. When an internal audit reveals potentially fraudulent discrepancies between care rendered and services billed on Medicare claims, determining the next steps can be tricky. Correcting faulty practices that led to the lapse is a given, but are broader legal actions necessary?
Admissions department and billing office staff know the importance of verifying benefits for prospective residents. By establishing a procedure to evaluate a beneficiary’s payer source prior to admission, SNFs can reduce possible claims adjudication issues and facilitate the receipt of payments in a timely manner.