MDS Alert

Getting paid isn't the litmus test for whether you filed clean claims - it's whether your claims have been audited and paid, says Rena Shephard, MHA, RN, FACDONA. That caveat can prevent a facility from assuming they're doing everything right when they are actually sailing in troubled compliance waters. "We're going through a period of few claims audits right now but that can and will change," Shephard notes. And fiscal intermediaries, the Centers for Medicare & Medicaid Services, and the Office of Inspector General are known for finding a particular issue. "Then they audit SNFs for that issue and recoup overpayments from those that weren't following the rules." Good News: CMS has decided not to recoup funds for SNF stays where residents lacked a bona fide prior three-day hospitalization.