TennCare maintains the right to audit or review all aspects of the case mix reimbursement system. Findings or adjustments generated from the audit or review may be used to adjust current or future NF provider reimbursement rates. The following are common aspects of the case mix reimbursement system that are subject to an audit or review process:

1. (1) NF provider MDS assessments, end-of-therapy date reconciliation submissions, and associated supporting documentation.
2. (2) NF provider quality incentive program add-on payment and supporting documentation.
3. (3) ERC services add-on payment and supporting documentation.
4. (4) NF provider submitted Medicare and Medicaid cost reports and supporting documentation.
5. (5) New NF provider submitted documentation.
6. (6) CHOW NF provider submitted documentation.
7. (7) NF provider submitted FRV updates, licensed bed totals, and requests for reappraisal.

Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-1413. Administrative History: Original rules filed May 1, 2018; effective July 30, 2018.