What Organizations Should Expect Regarding TPE Audits for Medicare Part A

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The Centers for Medicare & Medicaid Services (CMS) launched the SNF 5-Claim Probe and Educate (SPE) in 2023 in response to a 15.1% improper payment rate under the Patient-Driven Payment Model (PDPM), identified in 2022 (2023). The probe was meant to audit five PDPM claims per skilled nursing facility (SNF) and offer education based on the findings. At the time of the roll out, CMS projected that providers with error rates under 20% could request…

Understanding the CMS Signature Compliance for SNFs

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Signature compliance isn’t just about meeting a technical requirement. For Skilled Nursing Facilities (SNFs), it plays a direct role in ensuring Medicare reimbursement, defending claims during audits, and supporting timely, appropriate patient care. Facilities need to pay close attention to the Centers for Medicare & Medicaid Services (CMS) signature requirements. What CMS Requires: Timely, Accurate, and Verifiable Signatures CMS has long required that signatures on medical records be complete, legible, and timely. In most cases,…

Strengthening Medical Director Roles in Skilled Nursing: A Timely Look Ahead

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Medical directors are central to the clinical integrity of skilled nursing facilities—but how involved are they, really? While federal regulations outline specific responsibilities, there’s growing concern that the roles of medical directors are inconsistently defined, poorly documented, or limited in practice. In response, the U.S. Department of Health and Human Services (HHS), through its Office of Evaluation and Inspections (OEI), has launched a federal review to assess how medical directors are engaged—and how that engagement…