Each year, the OIG identifies healthcare programs that are vulnerable to fraud, waste, and abuse through erroneous claims. Using claim sampling techniques and audits, the OIG identifies billing vulnerabilities and
concerns specific to SNFs. Results of these vulnerabilities are published as reports or listings of common errors and should be analyzed to determine whether they are concerns for your facility.
With the implementation of the Patient-Driven Payment Model (PDPM), SNF’s bottom lines are more at risk than ever before.
In these early days of PDPM, SNFs may find it difficult to project revenue and profitability for their Medicare Part A covered patients because so many factors, (e.g., patient acuity, clinical documentation, accurate ICD-10 coding) impact payment, says Kim Cusson, CCS, CPC, a consultant with Crowe Healthcare Risk Consulting, LLC.