The financial health of a skilled nursing facility is highly dependent on the management of the Medicare A beneficiaries admitted for a skilled nursing stay and the ancillary services provided by therapy for the long term care residents under Medicare B. It is important to ensure that the provider of services can affect an optimal and appropriate level of Medicare A and B Utilization. With the increased scrutiny of Medicare intermediaries and with the proliferation of reviews and audits it has become critically important for the provider of services to consistently demonstrate that the skilled services are supported by the therapy and nursing documentation and the medical record, in its entirety, in a manner that meets the criteria for the medical necessity of skilled services as defined in 30.2.1 and 184.108.40.206. As such, the utilization of Medicare A and B services should appropriately reflect a facility’s census and acuity and the facility should in turn be appropriately reimbursed for the services provided.
Theracore performs extremely thorough Due Diligence Audits for prospective buyers and sellers of Skilled Nursing Facilities. The information provided to our clients has alerted numerous buyers and sellers to any potential risks for exposure to Medicare audits and denials subsequent to purchase/sale. Additionally, Theracore details the realistic revenue potential of a facility, based upon its census and acuity given what would be considered allowable Medicare A and B reimbursement.
Theracore evaluates the historical and current performance of the facility as related to Medicare compliance for their Medicare A admissions for coding, billing and documentation of therapy services, the accuracy of the MDS as related to the corresponding RUG –III assignment and the assignment of the HIPPS rate code and the Medicare compliance for ancillary charges billed by therapy under Medicare B. They also assess Medicare A and B therapy distributions and utilizations with a comparative analysis to the expected distributions and utilizations given the facility census and acuity.