Medicare Compliance & Reimbursement
Many SNFs' Dual-Eligible Claims Not Up To Snuff
Billing for patients with both Medicare and Medicaid coverage can be tricky for skilled nursing facilities. But a March 31 audit of the Texas Department of Human Services dropped a few hints on how SNFs can get the matter cleared up.
In the report, titled "Review of Medicaid Long-Term Care Payments for Individuals with Both Medicare and Medicaid Coverage" (A-06-03-00040), the HHS Office of Inspector General sent the state knocking on the doors of nursing homes in order to recoup over $7,800 in overpayments that occurred between January and June of 2001. What went wrong? Medicaid long-term care payments that incorrectly overlapped with SNF Medicare payments, and Medicare co-payments that were unallowable because they fell within the first 20 days of the original SNF admission date.
How to get a leg up on the problem: SNFs should be sure they brush up on the admission and discharge reporting responsibilities set up by the Centers for Medicare & Medicaid Services for dual eligible claims, and that corresponding support documentation is in place to fill in the gaps should the state come calling.
To read the report go to .
Lesson Learned: Skilled nursing facilities that have slid on dual eligible reporting requirements could be in for a reminder -- and a financial adjustment -- from state agencies.
Medicare Compliance & Reimbursement
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