Tag: proper documentation

Pre-pay audits target J5 providers in IA, KS, MO, NE and national

J5 Jurisdiction providers are being targeted for prepayment, service specific, complex medical reviews of Inpatient SNF services conducted by Wisconsin Physician Services Government Health Administrators (WPS GHA), a Medicare Administrative Contractor (MAC) for the Centers for Medicare & Medicaid Services (CMS). J5 Jurisdiction includes skilled nursing facilities (SNF) that submit claims from Iowa, Kansas, Missouri, […]

Evidence-based criteria for determining whether services are skilled

Editorial Note: This post is an excerpt from HCPro’s title Long-Term Care Skilled Services: How to Document for Proper Medicare Reimbursement by Elizabeth McLaren. Chapter 8 of the Medicare Benefit Policy Manual, Section 30.2.2 (“Principles for Determining Whether a Service is Skilled”) starts to look more closely at the criteria for assessing a skilled need. […]