Long-Term Care

The triple-check system: A proactive approach to Medicare compliance

Billing Alert for Long-Term Care, April 1, 2009

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Each year, the Office of Inspector General (OIG) identifies government programs under the Department of Health and Human Services that are vulnerable to waste and abuse through the submission of erroneous claims. Audits and investigations that were highlighted in a 2006 OIG report found potential Medicare overpayments in the amount of $542 million.


This year, the OIG will review a sample of Medicare claims submitted by SNFs to determine the accuracy of coding on resource utilization groups’ (RUG) claims, appropriateness of Part B services billed during a Part A SNF covered stay, calculation of Medicare days as it relates to no-pay bills, and MDS accuracy, according to the OIG’s 2009 Work Plan.

In the long-term care industry, these issues are typically addressed through Medicare audit programs, such as the Comprehensive Error Rate Testing, Recovery Audit Contractor, and Medicare Medical Review Programs.

A solid triple-check system designed to internally audit claims prior to submission may decrease your facility’s chances of being audited and improve cash flow to facility operations.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

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