The Centers for Medicare & Medicaid Services trimmed reimbursements to skilled nursing facilities by about $1 billion last year, due to what the agency described as actions that would “reduce payment error vulnerabilities.”
In a recent fact sheet, CMS said it was able to reduce improper payments through simplifying policies, rolling out prior authorization initiatives, and conducting a “targeted probe and educate” strategy to pinpoint what it deems are outlier providers.
For skilled nursing facilities, that has resulted in a $1.04 billion decrease in estimated improper payments from 2017 to 2018 in Medicare Fee for Service. During that same time, the SNF improper payment rate decreased from 9.33% last year to 6.55% this year, CMS noted.
“CMS is pleased to have achieved this decline in the Medicare FFS improper payment rate and continues to explore additional opportunities to reduce the improper payment rate,” the agency stated in its fact sheet. “We remain committed to collaborating across CMS and with stakeholders to address potential vulnerabilities, strengthen our program integrity efforts and minimize unnecessary administrative burden for our partners.”
SNFs were not alone in this endeavor, as home health corrective actions also resulted in a $6.92 billion reduction in payments from 2015 to this year. CMS said this is the first year in reporting history that Medicare FFS, Medicare Part C and D, Medicaid and the Children’s Health Insurance Program have achieved reductions in all five programs’ improper payment rates.
