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Region

Region D

Issue Title

Prepayment Review of Skilled Nursing Facility and Coding Validation

Number

D001302013

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

PA, MI, IL, OH, FL, TX, LA, NC, CA and MO

Provider Type

Skilled Nursing Facility

Date of Service

 

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

12/18/2013

Date Revised

 

More Information

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Attachments

Created at 3/21/2014 3:31 PM by i:0#.f|crmmembershipprovider|agough@ahca.org
Last modified at 3/21/2014 3:32 PM by i:0#.f|crmmembershipprovider|agough@ahca.org