Starting in June, skilled nursing facilities (SNFs) across the United States will undergo an audit of five Medicare Part A claims by the Centers for Medicare and Medicaid Services (CMS). The audits will be conducted by Medicare Administrative Contractors (MACs) in all regions. The aim is to address the high improper payment rate of SNFs and provide education to prevent future errors in billing practices.
Starting in June, the Centers for Medicare and Medicaid Services (CMS) will initiate a comprehensive audit of Medicare Part A claims for skilled nursing facilities (SNFs) in the United States. According to a memo released by the agency on May 15, the audit will involve a review of five claims per facility.
The audits will be conducted by the Medicare Administrative Contractors (MACs) in all regions. This decision follows a recent evaluation that revealed a projected improper payment rate of 15.1 percent for SNFs in 2022, representing a 7.79 percent increase compared to the previous year.
In the CMS memo, it states, “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 purpose of this widespread review is to lower the SNF’s 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.”
CMS emphasizes that these changes are aimed at rectifying billing practices and gaining further insights to prevent future errors through enhanced education and guidance.