Long-Term Care

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

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

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

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 PPS Alert for Long-Term Care.

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