Trained professionals perform a review of Medicare Part A Skilled Nursing Facility (SNF) claims, including but not limited to the following:
- Verification of appropriate bill type and revenue codes specific to SNF billing.
- Verification of discharge status indicators
- Verification that certification and recertification statements are completed in compliance with Medicare guidelines.
- Verification of RUG codes billed based on the MDS data for the corresponding billing period; verification of RUG modifiers/indicators.
- Verification that therapy visit and minutes reflected on the MDS form are supported by documentation in the medical record.
- Verification that the level of care documented in the medical record supports the RUG level billed for the corresponding time period.
- Verification of rehabilitation potential, therapy plans of treatment, therapy progress notes, and therapy daily records of treatment.
- Verification that therapy plans of treatment are approved by the physician.
- Verification of occurence code 70, and occurence span dates of at least 3 calendar days indicating a qualifying inpatient hospital stay.
- Verification that services subject to the consolidated billing provision of the SNF Prospective Payment system are billed appropriately.
- Verification that services listed on the itemized statement/patient account detail are documented in the medical record, excluding medication and supplies.
- Identification of documentation deficiencies or irregularities.
