On November 29, 2023, the OIG released an article issuing a background screening audit conducted in the State of Louisiana in May 2021. The OIG sampled 9 of 276 nursing homes, and a total of 286 employees. Out of the 286 employees, 77 were licensed staff. The audit showed all 9 nursing homes met federal and state regulations and 77 of the licensed staff did not have any disciplinary actions against them. However, the OIG…
The Patient-Driven Payment Model (PDPM) is the reimbursement methodology for Medicare Part A that has been implemented for Skilled Nursing Facilities (SNFs) since October 1, 2019. The PDPM was designed to improve the accuracy of Medicare reimbursement to SNFs by basing the payment on the patient’s clinical characteristics and care needs rather than on the therapy minutes provided. PDPM has complexities that should be considered. To ensure accurate reimbursement, it is imperative to correctly code…
‘Tis the season for a lot of things merry, but appeal and denials are not so cheery. Requests from Medicare Administrative Contractors (MAC) in the Skilled Nursing Facility (SNF) and Medicare Part B outpatient clinics are on the rise. Time is of the essence when a facility receives communication from a MAC; however, some requests are more impactful than others. Let’s review the various types of appeals and the focus areas. The Centers for Medicare…
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