On May 15, 2023 CMS posted Transmittal 12037: Skilled Nursing Facility (SNF) 5-Claim Probe and Educate Review. With this Change Request (CR) CMS directs the Medicare Administrative Contractors (MACs) to perform a 5-claim probe and educate medical review on every SNF within their jurisdictions with an effective date of June 5, 2023. The intention of this review is to lower the SNF improper payment rate. As a result, if an improper payment is identified through this process, the MAC will adjust the individual claim payment and provide education, including an explanation for the denial or adjustment of payment. For more information, please refer to the attached memorandum.
