PDPM Claim Probe Review: SALT Sweetens Provider Preparation

Skilled Nursing is plagued by inaccurate and inconsistent data. The Medicare claim (UB-04), while imperfect, offers a stable foundation for reimbursement analytics and even allows for cross-provider analysis. CMS uses SNF claim data to identify atypical Medicare billing patterns that reflect areas of potential concern. Specifically, its Program for Evaluating Payment Patterns Electronic Report (“PEPPER”) benchmarks utilization to guide providers through their auditing and monitoring efforts.

Click here to read the full article