OIG to take on nursing home reimbursements, complaints in FY 2017

OIG will review some SNFs' documentation to determine if their therapy billing is appropriate
OIG will review some SNFs' documentation to determine if their therapy billing is appropriate

Federal health officials will take a closer look at Medicare reimbursements and therapy billing in nursing homes during fiscal year 2017, according to a report issued Thursday.

The Department of Health and Human Services' Office of Inspector General plans to review skilled nursing facility reimbursements over the course of the year, the agency said in its Fiscal Year 2017 Work Plan, with a special focus on therapy documentation.

“Previous OIG work found that SNFs are billing for higher levels of therapy than were provided or were reasonable or necessary,” the report reads. “We will review the documentation at selected SNFs to determine if it meets the requirements for each particular resource utilization group.”

The office also plans to conduct reviews into how state agencies conduct nursing home complaint investigations, whether incident of abuse and neglect at nursing facilities were properly reported, and the outcomes of the National Background Check program for long-term care employees.

The OIG's findings for these newly announced nursing home-related reviews are expected to be issued during FY 2017.

Previously announced reviews that will continue in FY 2017 include one gauging compliance with the skilled nursing prospective payment system's requirement of a 3-day inpatient stay, as well as ones on potentially avoidable hospitals and hospices' compliance with medicare requirements.

Click here to read the OIG's full FY 2017 Work Plan.