Known for its intense scrutiny of therapy billing practices, a government watchdog on Monday cleared an Oklahoma City skilled nursing facility that placed 93% of its patients in the Very High or Ultra-High categories during a one-year period.
According to a five-page report issued by the Department of Health and Human Services’ Office of Inspector General, the therapy resource utilization groups at Epworth Villa Retirement Community’s skilled nursing facility all “were properly supported.”
The OIG vindication of Epworth could be taken as proof that some population mixes demand high-intensity care. Officials at the community, which offers a continuum of services, declined to comment on the findings Monday.
The audit included a 100-claim sample from 710 claims between July 1, 2016, and June 30, 2017, each with at least eight days of services. The OIG found therapy minutes supported the appropriate category for all cases, even though 94% of Epworth’s Very High and Ultra submissions were within 10 minutes of the category minimums.
OIG has been focused on therapy billing since at least 2015, when HHS called for a crackdown on fraudulent practices. Several major companies have been drawn into multimillion dollar settlements after being accused of inflating minutes, and the industry has repeatedly been called on the carpet by the Justice Department and in media reports.
Under the current therapy model, providers get a very high reimbursement rate if patients receive 500 to 719 minutes of therapy over a week’s time, or the highest possible reimbursement if they receive 720 minutes or more as part of the Ultra-High category.
Though the use of RUGS will end with implementation of the Patient-Driven Payment Model starting October 1, providers will still be asked to document therapy minutes to ensure levels of care don’t spike or fall off dramatically.
