AUDIT: RACs to Focus on DME in SNF Stays

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This audit-focused article discusses Medicare payment oversight for durable medical equipment in nursing home settings, particularly when beneficiaries are not in a Part A stay. It summarizes findings from the HHS Office of Inspector General, CMS comments, and the planned use of Recovery Audit Contractors and claims-processing controls to address the issue. The article is relevant to health care auditors, reimbursement staff, compliance teams, and providers who bill Medicare for DME tied to skilled nursing facility stays.

Why This Topic Matters

The article highlights a Medicare payment integrity issue affecting DME claims linked to nursing home residents and explains why federal agencies are considering additional audit and claims-review mechanisms. It helps readers understand the broader compliance and oversight context for DME reimbursement in facility settings.

What You Will Learn

  • The Medicare payment integrity issue involving durable medical equipment in nursing home settings
  • How HHS OIG and CMS describe oversight concerns related to non-Part A stays
  • The role of Recovery Audit Contractors in identifying potentially improper payments
  • The general types of administrative data and claims controls discussed by the agencies

Who Should Read This

  • Medical coders
  • Billing staff
  • Compliance professionals
  • Revenue cycle teams
  • Healthcare auditors
  • Skilled nursing facility administrators

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