AHCA: Scathing report fails to consider new care needs

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A federal report that blasts Medicare coding and resident stay practices drew a quick reply from one of the nation's leading provider organizations.

The American Health Care Association countered that “the long-term and post-acute care community is working in a coordinated manner with other providers to ensure patients and residents are in the most appropriate, most cost-effective and least restrictive care setting.”

A recent report by the inspector general's office of the Department of Health and Human Services suggested many providers—particularly for-profits—were unnecessarily extending stays for Medicare-eligible residents while placing them in the highest possible payment categories. These practices netted the industry an additional $5 billion in government reimbursement over two years, investigators alleged.

The IG called for stricter facility monitoring. Investigators also pointed out nearly 350 “worst offenders” to CMS officials for possible punitive action.

AHCA implied that investigators may not appreciate changes in long-term care:

“Our patient population consists of more medically complex patients, and often [this] necessitates placing their care in a higher RUG designation,” AHCA noted. The group promised it would work more closely with CMS.
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