Review of Selected Ohio Skilled Nursing Facilities' Minimum Data Set Reporting for Purposes of Medicare Payments to Managed Care Organizations

EXECUTIVE SUMMARY:

Our objective was to evaluate whether nine selected skilled nursing facilities in Ohio accurately reported the long-term status of institutionalized beneficiaries to ensure proper Medicare payments to the managed care organizations.  The nine selected Ohio skilled nursing facilities followed Federal regulations (42 CFR 483.20(b)(1)) and accurately and completely reported assessment information for long-term care facility residents the State specified reporting document or Resident Assessment Instrument.  Minimum Data Set assessments of one hundred beneficiaries in a six-month period included discharges and re-entry assessments in compliance with the 14-day rule.  We confirmed that the correct determinations of resident institutional status were made.  As a result, the referring managed care organizations received the correct institutional payment for all one hundred beneficiaries reviewed.  Therefore, no recommendations were warranted.