Industry view differs on rehab 'overbilling'
Regulators outline new process for manual medical review of therapy claims
A news report about therapy overbilling has provoked outrage on the part of nursing home operators.The story, which appeared in The Washington Post on March 29, alleged that nursing homes are reaping profits by incorrectly placing residents in the “ultra-high” categories for specialized care and rehabilitation.
So-called “upcoding” has helped to increase their profits and contribute to millions in Medicare overpayments over the last decade, according to the Post.The story focused on North American Health Care, a chain that operates 35 facilities, mostly in California.
A total of 64% of NAHC patients are billed in the highest category, while the national average is 9%, according to the Post.The article paints a “negative, incomplete picture” of the role and benefits of skilled nursing care, two long-term leaders wrote in response.