Medicare Compliance & Reimbursement

Here's what SNFs need to know to get things done right.

Billing for patients with both Medicare and Medicaid coverage can be tricky for skilled nursing facilities. But a March 31 audit of the Texas Department of Human Services dropped a few hints on how SNFs can get the matter cleared up.
 
In the report, titled "Review of Medicaid Long-Term Care Payments for Individuals with Both Medicare and Medicaid Coverage" (A-06-03-00040), the HHS Office of Inspector General sent the state knocking on the doors of nursing homes in order to recoup over $7,800 in overpayments that occurred between January and June of 2001. What went wrong? Medicaid long-term care payments that incorrectly overlapped with SNF Medicare payments, and Medicare co-payments that were unallowable because they fell within the first 20 days of the original SNF admission date.

How to get a leg up on the problem: SNFs should be sure they brush up on the admission and discharge reporting responsibilities set up by the Centers for Medicare  & Medicaid Services for dual eligible claims, and that corresponding support documentation is in place to fill in the gaps should the state come calling.

To read the report go to http://oig.hhs.gov/oas/reports/region6/60300040.pdf.

Lesson Learned: Skilled nursing facilities that have slid on dual eligible reporting requirements could be in for a reminder -- and a financial adjustment -- from state agencies.