On 5/4/23, CMS alerted providers of a 5-claim PDPM probe review to be conducted by Medicare Administrative Contractors (MACs) for every SNF in their respective jurisdictions, effective 6/5/23.
Proactive provider action is recommended to:
- Notify billers to ensure timely identification of ADR requests
- Validate each facility address on file to ensure receipt of correspondence
- Ensure presence of PDPM source documentation within the medical record
- Establish an internal process for assembly, submission and tracking
Link to CMS Transmittal 12015, a one-time notification, https://www.cms.gov/files/document/r12015otn.pdf
The Point Is: Every PDPM provider will be subject to this review. Take steps now to solidify an internal process for successful management of the audits.
