tci Medicare Compliance & Reimbursement - 2005 Issue 34
ENFORCEMENT WATCH: Medicare May Dictate Medicaid-Allowable Costs
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Article Overview
This enforcement-focused article reviews an HHS Office of Inspector General audit of a nursing facility’s Medicaid cost report and the related reimbursement implications. It is relevant to providers, coders, compliance staff, reimbursement professionals, and auditors who work with Medicaid cost reporting, Medicare reimbursement principles, and state-level payment calculations. The article discusses the types of costs reviewed, the role of Medicare fiscal intermediary review, and the broader compliance issue of aligning cost reports with applicable federal and state requirements.
Why This Topic Matters
It highlights how cost reporting rules and reimbursement oversight can affect Medicaid payments and trigger repayment actions when reported costs do not meet applicable requirements.
What You Will Learn
- How an OIG audit can affect Medicaid cost reporting
- Why Medicare reimbursement guidance may matter in Medicaid cost reports
- What kinds of cost-reporting issues may lead to questioned costs and overpayments
- How audit findings can lead to resubmission of a cost report and repayment review
Who Should Read This
- Healthcare providers
- Reimbursement professionals
- Compliance officers
- Medical auditors
- Facility administrators
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