The Comprehensive Error Rate Testing (CERT) program projects an improper Medicare Part A payment rate to skilled nursing facilities (SNF) of 15.1% in 2022, nearly double the 7.79% improper payment rate in 2021, and the highest improper payment rate of any category of health care facilities.
In response, and as described in the Centers for Medicare & Medicaid Services’ (CMS) Skilled Nursing Facility (SNF) 5-Claim Probe and Educate Review, CMS has initiated a process requiring Medicare Administrative Contractors (MACs) to review five Medicare claims for each Medicare-certified skilled nursing facility. Beginning June 5, 2023, SNFs with an error rate of 20% or lower (one in five claims in error) will receive widespread education; SNFs with an error rate higher than 20% will be offered one-on-one education. MACs will prioritize SNFs that had errors in all five claims reviewed.