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

Long-term care continues to lead in deal volume and value: PwC report

Long-term care continues to lead in deal volume ...

Long-term care bucked healthcare industry trends with strong merger and acquisition activity in the second quarter of 2014, according to newly released data from professional services firm PricewaterhouseCoopers.

Empowering nurse practitioners could reduce hospitalizations from SNFs, study finds

Granting more authority to nurse practitioners is associated with reduced hospitalization of skilled nursing facility residents, according to recently published findings.

Pioneer ACO drops out of program, despite reductions in skilled nursing utilization

A California healthcare system has become the latest dropout from the Pioneer Accountable Care Organization program, despite reducing skilled nursing facility utilization and improving its readmission rates. Sharp HealthCare announced its decision in a quarterly financial statement released Tuesday.