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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 IHCP members.

Review Frequency

The FSSA contracts with Myers and Stauffer to complete periodic minimum data set (MDS) reviews for all residents of Medicaid-certified nursing facilities in Indiana, regardless of payer source. Every Medicaid-certified nursing facility in Indiana is reviewed a minimum of once every 3 years. (Year is defined as the State fiscal year – July 1 through June 30.)

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

RAC Audits

The IHCP Recovery Audit Contractor (RAC) performs comprehensive reviews of financial activity for each Medicaid-enrolled resident in IHCP extended care facilities. For more information about RAC audits, see the Medicaid Recovery Audit Contractor (RAC) Overview 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:

IN Help Desk
(317) 816-4122

For questions related to record sequencing, error messages, assessment corrections, Resident Roster Reports, and Medicaid Resource Utilization Group (RUG-IV) calculations associated with all OMPP reports, call (317) 816-4122.

Gainwell Technologies Long-Term Care Help Desk

For questions related to correcting erroneous autoclosures, 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, contact Curtis Warfield or Dave Fowler at (317) 233-7206 or via email at mds-oasis@isdh.in.gov.

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