High therapy billings trigger audits: CMS

Ultra High billing accounted for the highest Medicare payments to SNFs, total therapy days and beneficiaries served, according to new data from CMS.
Ultra High billing accounted for the highest Medicare payments to SNFs, total therapy days and beneficiaries served, according to new data from CMS.

Federal regulators say startling data about the amount of therapy given at the highest levels compelled them to call in recovery audit contractors.

The Centers for Medicare & Medicaid Services released the Skilled Nursing Facility Utilization and Payment Public Use File on March 9. Its implications are damning, officials implied.

Ultra High therapy billing accounted for the highest Medicare payments to SNFs and total therapy days in 2013. The Very High resource utilization groups ranked next.

Many beneficiaries in the Ultra High and Very High RUGs barely made it over thresholds to get into those categories. Payments for these RUGs often exceed payments for others by 25%, CMS said.

“CMS strives to ensure that patient need, rather than payment system incentives, are driving the provision of therapy services,” said Shantanu Agrawal, M.D., deputy administrator and director of the Center for Program Integrity at CMS. He said he hoped “data transparency will facilitate real changes.”