Medicare Audits

Long-term care facilities have always been held accountable against a wide range of obligations in order to provide services to residents and receive Medicare or Medicaid reimbursement. 

The Affordable Care Act (ACA) introduced additional provisions aimed at preventing and reducing fraud, waste and abuse. As a condition of participation in federal health care payment programs, long-term care facilities are now required to develop and implement an effective compliance plan and have become the target of frequent audits from various sources, including MAC, RAC, and ZPIC, among the growing list. Kris B Harmony (KBH) has developed proprietary, comprehensive audit tools that assist with the identification and prioritization of target areas defined by governmental agencies. These KBH audits are essential for facilities to maintain a compliant landscape and determine key educational opportunities.

How can Kris B Harmony (KBH) help?

The objective of Harmony's Medicare Audit site visit is to review the medical records for information that supports the clinical services provided and documented on the MDS as they relate to RUG-IV and outpatient Part B reimbursement. In addition, this process investigates compliance by employing CMS rules and regulations using a retrospective and current caseload sample. All recommendations provided by KBH are based on patient-specific, clinically indicated services combined with supporting documentation. KBH identifies areas of opportunity based on direct caregivers' observations, staff interviews, and clinical assessments, along with the review of medical record documentation. KBH's recommendations impact the facility’s internal processes and thus impact the revenue cycle. Our goal as KBH Consultants is to insulate the facility’s revenue stream while educating the clinical team in the process of case management in accordance with Medicare SNF guidelines. With these shared tools and monthly oversight for accountability built into the system, goals will be attained.


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