Probe & Education Review Letters
Skilled Nursing Facilities are beginning to receive letters from CMS/CGS regarding the Probe and Educate review process. CMS will have its auditors conduct reviews of five claims per SNF – providers with an error rate of 20% or less will receive education of some kind, while those with an error rate greater than 20% will receive one-on-one education with a Medicare Area Contractor (MAC). MACs were directed to start with providers that show the highest risk. See articles below.
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Leah Shoulders, Director of Revenue Management