tci Medicare Compliance & Reimbursement - 2014 Issue 1

Know These Crucial SNF Target Area Definitions

What CMS looks at when finding improper Medicare payments. To understand your Program for Evaluating Payment Patterns Electronic Report (PEPPER), you need to know the definitions of the target areas. The Centers for Medicare & Medicaid Services (CMS) has defined these six target areas as follows: Therapy RUGs with High ADLs. Numerator: Count of days billed with RUG equal to RUX, RVX, RHX, RMX, RUC, RVC, RHC, RMC, RLB. Denominator: Count of days billed for all therapy RUGs. Non-Therapy RUGs with High ADLs. Numerator: Count of days billed with RUGs equal to SSC, CC2, CC1, BB2, BB1, PE2, PE1...

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