Exception Reviews

Minimum Data Set (MDS) assessments are an incredibly important way that Medicare or Medicaid certified nursing facilities receive appropriate funding to best care for their residents. In the state of Ohio, the Department of Medicaid has instituted Exception Reviews in order to evaluate the reimbursement rate that certain nursing facilities receive. The review aims to ensure that a nursing facility’s reimbursement rate is correct by sampling the MDS data reported by the facility to Medicaid. This process evaluates multiple components of the medical record to determine if the MDS coding is accurate and can be supported. The results of this audit can lead to financial penalties that impact 6 months of Medicaid reimbursement.

While the thought of a Medicaid reimbursement rate change could be an overwhelming one, assistance from a qualified consulting firm can help to mitigate the impact. If your facility or organization has been notified of an upcoming Exception Review or has received the findings letter from a completed review, LeaderStat’s experienced Consulting team is able to help with each step of this process and can offer expert advice to help you navigate this task successfully.