November 2011

CMS Announces Demonstration
to Reduce Improper Payments

On November 15, CMS announced it will launch several demonstration programs beginning in January 2012 that will target some of the most common factors that lead to erroneous payments in the Medicare and Medicaid programs. Among the issues that potentially can impact senior living providers is the initiation of a recovery audit prepayment review program.

According to the announcement, as part of the prepayment review demonstration program, recovery auditors will be allowed to review claims before they are paid to ensure the provider complied with all Medicare payment rules.  The auditors will target prepayment reviews to those types of claims that have historically resulted in high rates of improper payments. The reviews will take place in seven states that have been shown to have high percentages of providers with a propensity for fraud and error-prone submissions: California, Florida, Illinois, Louisiana, Michigan, New York and Texas. The demonstration program will also focus on four states with high percentage of claims for short inpatient stays: Missouri, North Carolina, Pennsylvania and Ohio. CMS believes the 11 state demonstration project will help lower error rates by preventing improper payments. This approach differs from the traditional “pay and chase” methods of looking for erroneous payments after they have been made.

To read the CMS fact sheet announcing the demonstration programs please click here.

Please contact a member of the ParenteBeard Senior Living Services Practice Group for more information about this communication or to discuss the services our experts can offer

Contact Us

Effective October 31, 2021 the Mechanicsburg office Senior Living Services Consulting group has relocated to ParenteBeard’s York, PA office and can be reached at 717.846.7000. Thank you.

For Senior Living Assurance and Tax Services: For Senior Living Consulting Services:
Mark Ross, Partner and Practice Leader, Senior Living Services Practice
Office:  570.820.0311
Cell:  570.313.1584
Jennifer Schwalm, Partner
Office:  717.846.7000, ext. 11226
Cell:  717.503.6590
Mike Frey, Partner
Office:  717.393.5696
Cell:  717.917.7756
Jarrod Leo, Principal
Office:  717.846.7000, ext. 11229
Cell:  717.571.3678
Brian Gabriel, Partner
Office:  215.972.2381
Cell:  267.218.2278
Mark Baron, Director
Office: 570.820.0315
Ben Jarmul, Partner
Office:  412.697.6437
Cell:  412.956.6075
Sophie Campbell, Director
Office:  724.775.5933
Cell:  724.601.7873
Julius Green, Partner
Office:  215.972.2352
Wendy Kiser, Director
Office: 419.367.9784
  Frank Mandy, Director
Office:  856.330.8147
Cell:  609.678.8274
  Mike Vucic, Director
Office:  570.820.0314
Cell:  570.947.9796

About Us

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Business Advisors With Administrators, former CFOs, licensed CPAs and RNs on staff, we offer a wide range of services, including strategic planning, market feasibility, operations assessment, review and improvement, development and finance solutions, and clinical advisory services.

Audit, Cost Report and Tax Solutions  We perform the audit for a number of state aging associations and approximately 250 continuing-care retirement communities, skilled nursing and assisted living facilities, and subsidized housing projects for the elderly. We also prepare more than 250 Medicare and Medicaid cost reports and nearly 1,000 federal Form 990s on an annual basis.