Long-Term Care

PPS Q&A

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

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Q. How do auditors determine what claims to review?

A. Within the past decade or so, contractors have seen a major shift in the way they identify claims for review. Rather than doing reviews of randomly selected claims, CMS requires its contractors to conduct more targeted reviews. To determine what types of claims to target, the contractor must conduct an analysis of data that results in claims filed to the program. 

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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