Therapy claims, ED transfers: OIG focus

Therapy claims, ED transfers: OIG focus
Therapy claims, ED transfers: OIG focus

The Office of Inspector General will be taking a closer look at several important long-term care subject areas and practices, according to its Fiscal Year 2015 Mid-Year Update.

One major point of focus will be Medicare Part A billing by skilled nursing facilities. Previous OIG reports found that SNFs increasingly billed for the highest level of therapy, despite beneficiary characteristics remaining largely unchanged. In addition to high billing, OIG also found that SNFs billed one-quarter of all 2009 claims in error, resulting in $1.5 billion in erroneous Medicare payments.

The rate of Medicaid beneficiary transfers from group and nursing homes to hospital emergency rooms also will be reviewed by the government watchdog.

Whether or not state survey agencies verified nursing home deficiency correction plans also will be evaluated.

The OIG update also includes plans to review state background check costs and procedures for prospective direct-contact long-term care employees.