Long Term Care
Myers and Stauffer performs retrospective on-site service
provision and case-mix reviews of certified nursing facilities on
behalf of the Indiana Health Coverage Programs (IHCP). Oversight is
provided by the Indiana Family and Social Services Administration
(FSSA) through the Division of Aging (DA) and the Office of
Medicaid Policy and Planning (OMPP) to help providers achieve
compliance in documentation and billing, as well as help ensure the
health and safety of the IHCP members.
The frequency of review varies, based on providers' risk levels.
The case-mix review frequency and provider risk categories
effective January 1, 2010, follow:
- A low-risk provider, defined as having a previous review score
of 90-100% supported, will be reviewed at least once every three
- A medium-risk provider, defined as having a previous review
score of 80-89.9% supported, will be reviewed at least once every
- A high-risk provider, defined as having a previous review score
of 79.9% or lower supported, will be reviewed every four to 12
The OMPP reserves the right to perform additional case-mix
reviews as deemed necessary at any time.
The FSSA contracts with Truven Health Analytics as the IHCP
Recovery Audit Contractor (RAC), which performs comprehensive
reviews of financial activity for each Medicaid-enrolled resident
in IHCP nursing facilities. For more information about RAC audits,
see the Medicaid RAC page on this site.
Other resources for providers with questions about long-term
Myers and Stauffer Help Desk
For questions related to the Medicaid case-mix reviews and
supportive documentation requirements, call:
Lynn Snider, BSN, RN, RAC-CT
For questions related to record sequencing, error messages,
assessment corrections, Resident Roster Reports and
Medicaid Resource Utilization Group (RUG-III) calculations
associated with all OMPP reports, call (317) 816-4122.
Hewlett Packard Enterprise Provider Relations Help Desk
For questions related to B98 and K98 auto-closures, call (317)
Indiana State Department of Health (ISDH) Clinical Help
For questions related to the clinical definition, intent,
completion, or interpretation of the Minimum Data Set (MDS) and
Resident Assessment Instrument (RAI), call Barbara Wheeler, RN, at
Indiana State Department of Health (ISDH) Technical Help
For questions related to all Centers for Medicare & Medicaid
Services (CMS) reports, including error messages, the Initial
Feedback Report and Final Validation Report, user IDs
and passwords for CMS, and difficulties with transmission to CMS,
call Curtis Warfield or Dave Fowler at (317) 233-7206.