Responding to the C.M.S. 5 Claim Review Process for

Skilled Nursing Facilities

Operational and clinical professionals must be prepared to lead their teams to respond to the new C.M.S. 5 Claims Audit Program. This session will describe the structure of the C.M.S. 5 Claims Review Process and the procedures used by C.M.S. auditors to approve Part A Medicare claims under review. Facilities must understand the documents needed to support Medicare Part A Claims and be able to respond to audit requests with complete documentation from the medical record and administrative documents. This session will provide guidance for the process to submit documentation to the M.A.C. when a case audit is requested by C.M.S. Audits have been active since mid 2023 and results of audits are showing patterns of denials, returned funds and many reasons for denial. This session will discuss audit outcomes and documentation issues. A must do session for operational and clinical managers as well as MDS managers and nurses. Case studies of actual audits to be discussed.

Objectives: 1) Identify the structure of the C.M.S. 5 claim Review Process 2) Review the required data from the MDS and other compliance documents that will be requested at audit 3) Discuss proactive steps facilities can take to monitor the quality of essential MDS data that contributes to payment rates 4) Describe current audit outcomes and reasons for payment denials 5) Discuss documentation formats that have satisfied audit inquiry and availability of forms to assist providers to meet the requirements

When: April 4, 2024 9:00 a.m. – 4:30 p.m.

Where: The Alliance Training Center 103 E. State St. Alliance

Instructor: Leah Klusch, RN,BSN, FACHCA

Cost: $125 per person

NAB approved for 6 CEUs

(330) 821-7616 to register.

We accept checks, Visa, Mastercard and Discover.

Payment holds your spot and seating is limited!