Blog Series: Part 1 – Technical Issues in PDPM Coding and Billing

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In this 3-part blog series, we will focus on issues that were identified in the recent OIG audit of PDPM records and MDS. The first area relates to a lack of documentation to support technical requirements. Billing and coding for medical services provided under the Centers for Medicare & Medicaid Services (CMS) should always be accurate and supported by requirements outlined in the regulations. For Skilled Nursing Facilities (SNF), billing for Medicare Part A is…

The Cost of Overlooking Monthly Exclusion Checks

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On September 29, 2025, a home health company in Arizona, agreed to pay $20,000 to settle allegations of violating the Civil Monetary Penalties Law (CMPL). The Office of Inspector General (OIG) alleged that the home health company employed an excluded individual—someone prohibited from participating in any Federal health care program—as a home health aide. The individual’s services were allegedly billed to these programs, triggering the violation. While $20,000 may seem modest in comparison to larger…

Are You Aware of the MDS Validation Program?

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Hopefully, you (and your Minimum Data Set (MDS) Coordinator or Resident Nurse Assessment Coordinator (RNAC)) are aware of the importance of checking the Validation Reports after submitting MDS assessments. This has always been the expectation and best practice to find any errors in a timely manner, make corrections, and ensure that MDS submissions are accurate and accepted. If you are in the habit of checking your Validation Reports in the Internet Quality Improvement and Evaluation…