OIG seeks immediate stop to 'excessive' Medicare billings

Share this article:
Mark Parkinson, AHCA president and CEO
Mark Parkinson, AHCA president and CEO
Medicare payments to skilled nursing facilities increased unexpectedly by $2.1 billion (16%) during the first six months of fiscal 2011, according to a report from the HHS Office of the Inspector General. The OIG has asked the Centers for Medicare & Medicaid Services to take “immediate action” that corrects such overpayments.

CMS recently implemented numerous changes in the skilled nursing facility prospective payment system. These include new procedures for billing individual, group and concurrent therapy. CMS expected these changes to be budget-neutral. Instead, many savvy providers began submitting bills for higher than expected amounts of high-level therapy. At the same time, billings for concurrent therapy — where payments would have been relatively lower — dropped precipitously.

Report authors also encourage changes to Rehab Ultra High criteria and Medicare payments to be “more consistent with beneficiaries' care and resource needs.”

The OIG said it would conduct a full review of skilled nursing facility billing at the end of the current fiscal year, and might make formal recommendations at that time.  Report authors nonetheless urged CMS to take action before then.
Share this article:

More in News

Bulk of Medicaid to be managed care in two years: Avalere

Bulk of Medicaid to be managed care in ...

More than three-quarters of Medicaid beneficiaries will be enrolled in a managed care plan as of 2016, according to an Avalere Health analysis released Thursday. The numbers reveal that managed ...

Nursing home asked for employee's personal information too often, jury rules

The human resources department of a Maine nursing home did not properly protect a former employee's personal identification information, a jury recently ruled.

Test could confirm sepsis within an hour

Nursing home residents might benefit from a new way of diagnosing and treating sepsis made possible by discoveries out of the University of British Columbia.