LTC leaders: News report on 'upcoding' distorts the facts

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Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care
Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care
The Alliance for Quality Nursing Home Care and American Health Care Association expressed outrage over a news report that alleged widespread use of so-called “upcoding” in nursing homes.

“This article paints a negative, incomplete picture of the growing role and tangible benefits associated with skilled nursing facility (SNF) patient care, and ignores the central fact SNFs are caring for higher acuity patients while also saving tax dollars,” Alan Rosenbloom, president of the Alliance, and Bruce Yarwood, president and CEO of AHCA, wrote in response to the article.

The Washington Post story alleged that nursing homes have been taking improper advantage of the creation of new higher reimbursement categories for therapy and acute care over the last decade.

Most recently, in 2006, officials with the Centers for Medicare & Medicaid Services expanded the number of Resource Utilization Groups (RUGs) to 53 from 44.

Yarwood and Rosenbloom contested the implication that “upcoding” is a standard practice among nursing homes.  
“Facilities must use specific regulatory tools to provide patient assessment, which then reflects the level of reimbursement,” they wrote. “Any suggestion that facilities are able to bill any way that they wish is simply false and misguided.”
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