Medicare Compliance & Reimbursement

Nursing homes will need to be proactive to dodge losses -- and even realize big gains. A visit from the Data Assessment Verification Project team may be enough to make even the coolest long-term care provider sweat, but consider this: In the long run DAVE may have a positive impact on reimbursement -- to the tune of $200,000 or more in a single quarter.

"It's a wake-up call," offers Leah Klusch, nurse consultant and executive director of The Alliance Training Center in Alliance, OH. Ever since the Centers for Medicare & Medicaid Services began piloting its now national initiative to ferret out discrepancies in minimum data set (MDS) data, nursing homes have been concerned that the mistakes discovered would weigh in CMS'favor. ADAVE-discovered mistake in Section P, for example, could lead a fiscal intermediary to invalidate a claim already paid for therapy services -- and to seek recoupment.

Good news: Such concerns are valid, experts agree, but providers should also see DAVE's better side, say Klusch and others. In many facilities, lack of coordination, poor communication and inadequate training all undermine administrators'efforts to secure appropriate reimbursement.

Here are some ways SNFs can make the DAVE spotlight work for them: 1. Face the facts. DAVE teams across the nation started visiting facilities May 1, reports a spokesperson for CMS. All in all, the teams plan to visit 88 facilities between now and the end of the year. Off-site surveys, which commenced in February, will also continue.

"We're just hearing the first reports of on-site visits," reports Rita Roedel, clinical operations consultant with BDO/Heritage Healthcare Group in Milwaukee. The lesson learned from these early reports: Preparation is key. Without preparation, SNFs could find themselves in the recent position of one facility. That provider was selected in early May for on-site review - and failed to realize at first that they'd received a request for information prior to review. This kind of oversight is easy to make, allows CMS. Typically, a provider will be notified of a pending visit just a few days before the team walks in with their clipboards.

Though the prospect of an on-site inspection may be the one that leaves providers sleepless, it's not the only reason to take stock of MDS, remind the experts. Afiscal intermediary can ask for money back for a claim deemed invalid just as easily from an off-site survey. And -- even more importantly -- if a facility's MDS coordinator and clinicians aren't communicating, the facility could already be losing money through assessments that fail to capture residents'real needs, stresses Klusch. Moneymaker: One provider that's stepped up MDS training and processes realized a remarkable $200,000 increase in reimbursement in just one quarter. "Most facilities [...]