The Centers for Medicare and Medicaid (CMS) has rolled out many initiatives since the Public Health Emergency ended in May of 2023. One initiative in specific is the Skilled Nursing Facility (SNF) 5-Claim Probe and Educate Review. If you still have not seen or heard about it, and you operate a SNF, you will! The Transmittal 12037 outlines the specific probe audit. The purpose of the audit is to lower the SNF improper payment rate.…
Interim staff play a crucial part in ensuring the smooth operation of senior living communities. These temporary positions are often filled by experienced professionals who step in during periods of transition or when a permanent position is vacant. Interim roles provide stability and continuity in senior living communities. When key positions like executive directors or department heads are suddenly vacant, it can create uncertainty and disrupt the daily operations of the facility. By bringing in…
In July 2023, the Office of Inspector General (OIG) added Medicare Part C High-Risk Diagnosis Codes (AKA Risk Adjustment) Tool Kit to their work plan, with the intention of creating a resource to assist Medicare Advantage (MA) organizations with analyzing the accuracy of their risk adjustment data, which, in turn, gets submitted to CMS for reimbursement purposes. What is Risk Adjustment (RA)? Risk adjustment is: Why is RA Important? Accurate documentation and coding of a…
Sign up today to receive our complimentary newsletter, Guidance on Compliance, with the latest healthcare compliance and risk management information.