RMB-3 - SNF Medicare Claims Compliance in 2025: Key Audit Target Areas to Focus On

After a period of limited claim auditing during the COVID-19 pandemic, the Centers for Medicare and Medicaid Services and its various claim audit contractors have rapidly accelerated their scrutiny of SNF Medicare Part A claims. In a recent CERT contractor audit report, the estimated improper payment amount for SNF services during the 2024 report period was $5.9 billion, resulting in an improper payment rate of 17.2 percent. This error rate was more than double the 2024 error rate of hospitals and other post-acute providers. It was also more than double the SNF 8.5 percent error rate in 2019. The vast majority of SNF errors in 2024 were related to insufficient documentation.

SNF claim compliance programs should focus on all care processes from prior-to admission through the end of care and all claims processing cycles associated with a resident’s Medicare stay. This session will highlight the major categories of Medicare claims audit contractors SNFs may encounter. Additionally, clinical documentation and billing experts will highlight the most common claim error trends they are seeing and suggested strategies to avoid being targeted for an audit or to successfully pass a claim audit without a full or partial denial.