How FIs view changes in therapy services during a payment period
Billing Alert for Long-Term Care, October 1, 2008
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Effective April 30, 2007, fiscal intermediaries and Part A/B Medicare administrative contractors conduct medical reviews of Medicare Part A skilled nursing facility PPS claims using automated MDS quality control (QC) system software. Medical review staff members obtain electronic copies of MDS assessments from the state databases, enter data from those MDSs in the MDS QC system software, and evaluate the associated medical record to calculate their resource utilization group (RUG) scores. The following excerpt from Section 6.1.3D, Bill Review Process: Outcome of Medical Record Review, in Chapter 6, “Intermediary Medical Review Guidelines for Specific Services,” of the Medicare Program Integrity Manual explains how Medicare contractors will approach claims in which the level of therapy services changed during the payment period:
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