Skilled nursing facilities (SNF) should perform a compliance self-audit to provide an opportunity to review the documentation in the medical record to ensure it is comprehensive, complete, and defensible in the event of actual auditor scrutiny. SNFs have always been held accountable to provide services to residents and receive Medicare or Medicaid reimbursement. The Affordable Care Act (ACA) introduced additional provisions aimed at preventing fraud and abuse. One condition requires that SNFs develop and implement an effective compliance plan.
Hospitals’ use of observation status continues to vex SNFs and patients, but with an election looming, changes to postacute care eligibility may not happen soon. SNFs have become all too familiar with a costly scenario: A patient leaves the hospital after a few days and moves on to a SNF, only to learn that Medicare won’t cover his or her SNF care as expected. The beneficiary is frustrated, and the SNF often inappropriately bills Medicare.
Although there have not been many changes to SNF Part A fee-for-service billing requirements in the past few years, there are still age-old problems that plague billing professionals and delay payments. By addressing these issues, SNF billers can avoid payment delays due to returned or rejected claims. Below are the top five issues that cause claim payment denials or delays and can hurt your facilities’ bottom line.
In its mid-year update to the Work Plan for fiscal year 2016, the Office of the Inspector General (OIG) indicated it intends to investigate hospitals’ compliance with the three-day stay rule for Medicare eligibility for postacute care. The three-day stay issue did not appear in the OIG’s initial Work Plan for FY 2016, and the mid-year Plan is vague about the review’s scope.