CMS: Five claim audit for all nursing homes to begin in June

Skilled nursing facilities across the U.S. will undergo an audit of five Medicare Part A claims from CMS beginning June 5, according to a May 15 memo from the agency.

The audits will be performed by the by Medicare Administrative Contractors across all regions. These changes come after a review revealed skilled nursing facilities were projected to have an improper payment rate of 15.1 percent in 2022, which CMS notes was 7.79 percent higher than in 2021.

"The purpose of this Change Request (CR) is to have the MACs perform a five claim probe and educate medical review on every SNF in their jurisdiction," the CMS memo reads. "The purpose of this widespread review is to lower the SNF improper payment rate. As always, if the MAC identifies an improper payment, the MAC will adjust the individual claim payment, as appropriate, in addition to providing education, including their explanation for denial or adjustment of payment."

The change request, CMS says in the memo, are part of an effort to both correct billing practices and provide additional insight into the education that may be needed to prevent future errors.

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