If every “i” is not dotted and every “t” not crossed when submitting a claim, an overpayment may result, even if services rendered to the patient were medically necessary. The appeals process is designed to give providers a chance to explain their case. It’s also a mechanism to make sure the audit was conducted properly. The following tips may not help you win every appeal, but they certainly won’t hurt your case.
A truly successful SNF optimizes quality outcomes and reimbursement for their Medicare Part A patients. The Patient-Driven Payment Model (PDPM) supports this concept by shifting the focus from quantity of services to drive payments to basing payments on resident characteristics and quality outcomes. Outcomes are person centered, and SNFs can utilize several programs to provide that person-centered care.