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Region

Region C

Issue Title

Prepayment Review: Skilled Nursing Facility and Coding Validation

Number

C004472014

Description

Skilled Nursing Facility claims will be reviewed to determine the extent to which the Minimum Data Set (MDS) is accurate and supported by the patient’s medical record. The entire benefit period will be reviewed to determine if the patient’s level of care was appropriately billed.

States

FL, TX, LA

Provider Type

Skilled Nursing Facility

Date of Service

3 Years from Initial Determination Date

References

  • MDS 3.0 RAI Manual Chapter 6, Section 6.4 
  • Skilled Nursing Facility FY2012 RUG IV Education & Training 
  • OIG Report OEI-02-09-00200. 
  • SNF PPS FY2012 Final Rule (76 FR 48486). 
  • Medicare Benefit Policy Manual, Chapter 8, Section 30.2

Date Posted

 

Date Revised

 

More Information

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Attachments

Created at 3/21/2014 3:28 PM by i:0#.f|crmmembershipprovider|agough@ahca.org
Last modified at 3/21/2014 3:28 PM by i:0#.f|crmmembershipprovider|agough@ahca.org