Improper payment rate for SNFs jumps to 11%

MedPAC will recommend site-neutral payments, but not for strokes
MedPAC will recommend site-neutral payments, but not for strokes

The improper payment rate for skilled nursing facilities increased to 11.04% in 2015 largely due to insufficient documentation, a new report has shown.

The U.S. Department of Health and Human Services' Fiscal Year 2015 Agency Financial Report found the improper payment rate for SNF claims rose by a net 60%, up from last year's improper payment rate of 6.94%

The primary cause for the increase was insufficient documentation, a “common” problem among skilled nursing facilities, the report noted. Medical necessity errors and administrative or coding errors also contributed to the rise.

The HHS report, which was released last week, also addressed the issue of therapy overbilling among SNFs, saying the department is “working to identify potential alternatives” to the existing therapy payment system. The reported noted the practice of therapy overbilling was “wasteful” and “compromised care” for SNF patients.

Findings also included news that the rate of improper Medicaid payments across the healthcare spectrum have almost doubled over the past two fiscal years.