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October 1, 2024
OIG requests Medicare Part C Pre-service Universes for Care in Long-term Acute Care Hospitals, Skilled Nursing Facilities, Inpatient Rehabilitation Facilities
We would like to inform you that a few of our clients received an audit notice from the Office of Inspector General (OIG) today in accordance with the OIG workplan. The OIG is specifically requesting data on pre-service determinations and reconsiderations for admission to long-term acute care hospitals, skilled nursing facilities, and inpatient rehabilitation facilities. The requested data includes two universe tables: Universe Table 1 for Standard and Expedited Pre-Service Organization Determinations (OD), and Universe Table 2 for Standard and Expedited Pre-Service Reconsiderations (RECON), but only for requests included in Table 1. It is important to note that each universe should only include requests for admission to long-term acute care hospitals, skilled nursing facilities, and inpatient rehabilitation facilities.
The first portion of the audit is submission of universes only.
Please note: The audit request applies to all your organization's contracts that cover Part C benefits and is closely aligned with CMS's audit universe requests. The OIG has added variables of interest to their evaluation. Plans are required to respond within 20 business days and will receive a data layout and an email with a link to upload the data in Microsoft Excel format. We believe that this audit is part of the report identified as OEI 09-24-00330 in the OIG work plan. We will work closely with our clients to provide the requested data accurately and within the specified timeframe.
In addition, we expect the OIG will roll out audits regarding the following to meet their report timing of 2025, so plans should also be aware and prepared for audits of Medicare Part C Supplemental Benefits.
You can review the OIG work plan: Work Plan | Office of Inspector General | U.S. Department of Health and Human Services (hhs.gov)
We will continue to keep you informed about any developments regarding OIG audits and their implications. BluePeak can support you from reviewing your universes pre-submission or support throughout the audit process.
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