RUGs

Medicare payments to skilled nursing facilities increased unexpectedly by $2.1 billion (16%) during the first six months of fiscal 2011, according to a new report issued by the Office of the Inspector General. The OIG has asked Centers for Medicare & Medicaid Services Administrator Donald Berwick to take "immediate action" to correct this overpayment.

After narrowly passing a healthcare stopgap bill that included a therapy caps extension package, Democrats in Congress are finding it difficult to bring their major reform proposal across the finish line, according to recent reports.

The looming Medicare payment system will encourage nursing home operators to embrace more clinically complex care, according to panelists who spoke Tuesday at the 2010 National Skilled Nursing Investment Forum. A favorable reimbursement level will push this case-mix shift, they noted.

A controversial new rule from the Centers for Medicare & Medicaid rule will recalibrate Medicare case mixes under the Resource Utilization Group (RUG) system. Specifically, it will eliminate a section of the Minimum Data Set (MDS) and change the RUG classification process for short-stay residents.

The Centers for Medicare & Medicaid Services late Friday issued a rule that will cut $360 million in Medicare payments to skilled nursing facilities for fiscal year 2010.