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Friday, September 20, 2013

Is the Government Coming After Skilled Nursing Facilities?

by James Swann

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If you're operating a skilled nursing facility (SNF), you can expect an increase in medical record reviews from a myriad of government agencies and contractors, according to a webinar I recently attended. Kris Mastrangelo, president and chief executive officer of Harmony Healthcare International, a consulting firm in Topsfield, Mass., said SNFs are facing intensive record reviews from the Department of Health and Human Services Office of Inspector General, the Department of Justice, Zone Program Integrity Contractors and Recovery Audit Contractors.

Mastrangelo said the increase in reviews is the result of a 2012 OIG report that said SNFs inappropriately received $1.5 billion in Medicare payments in 2009. She outlined several steps SNFs should take to prepare for reviews, including making sure that all therapists have a thorough understanding of Medicare reimbursement policies and ensuring that all therapists are licensed. 

Mastrangelo was joined on the webinar by Elisa Bovee, Harmony's vice president of operations, who said SNFs should review their Program for Evaluating Payment Patterns Electronic Reports (PEPPERs). PEPPERs allow SNFs to compare Medicare claims data for high-risk services with other SNFs on a national, jurisdictional, and state level, and can help prevent inappropriate Medicare claims.
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