Long Term Care

case-mix reviews

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.

Review Frequency

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 years.
  • A medium-risk provider, defined as having a previous review score of 80-89.9% supported, will be reviewed at least once every two years.
  • A high-risk provider, defined as having a previous review score of 79.9% or lower supported, will be reviewed every four to 12 months.

The OMPP reserves the right to perform additional case-mix reviews as deemed necessary at any time.

RAC audits

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.

Additional Support

Other resources for providers with questions about long-term care follow.

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
(317) 846-9521
lsnider@mslc.com

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) 488-5094.

Indiana State Department of Health (ISDH) Clinical Help Desk

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 (317) 233-4719.

Indiana State Department of Health (ISDH) Technical Help Desk

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.