Long-Term Care

Preparing your facility for an audit

PPS Alert for Long-Term Care, July 1, 2010

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There has never been a time when the government has been more intent on reducing improper payments in the Medicare and Medicaid programs than now. That, coupled with current healthcare reform initiatives, has made auditing of healthcare providers that bill the federal government a primary focus. Current legislators have certainly realized the extent of improper payments in recent years, as evidenced by the increased scrutiny of CMS and what it determines to be a lack of oversight and inability to gain control of the growing problem. 

The government’s primary tool in detecting improper payments is analysis of claims data to detect aberrancies, followed by audits of the activities causing the abnormal behavior. Essentially, this means there will be more auditors conducting more audits. We are already seeing the effects of this with the expanded Recovery Audit Contractor (RAC) program and transition to Zone Program Integrity Contractors with expansion of the Medi-Medi program, which cross-analyzes Medicare and Medicaid data. 

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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