With the Medicare Complete Error Price Testing program projected error charge for expert nursing services (SNFs) exhibiting a big improve in 2022 (15.1%, up from 7.9% in 2021), the Facilities for Medicare and Medicaid Companies (CMS) has instructed every of its Medicare Administrative Contractors (MACs) that evaluation SNF Medicare claims to provoke a five-claim probe and educate medical evaluation for every SNF within the MAC’s jurisdiction.

CMS surmises that the supply of the rise in improper funds might lie with the change from useful resource utilization group (RUG) IV to the affected person pushed fee mannequin (PDPM) and has famous that the first root reason for SNF errors is lacking documentation. 

MACs are instructed to implement the five-claim probe on a rolling foundation starting with the highest 20% of SNFs that present highest threat. If any improper funds are recognized, the MAC will modify (or deny) the declare(s) and provide both widespread training or 1:1 individualized training relying on the error charge. 1:1 training will embody declare particular info and permit the SNF to evaluation the declare choice, ask questions and obtain suggestions.

Starting June 5, 2023, SNFs nation-wide ought to be looking out for a prepayment probe and educate file request from the MAC and be ready to reply inside 45 days. In case you have questions on CMS’ probe and training evaluation course of, the at Sheppard Mullin is on the market to help.