Tuesday, December 28, 2010

OIG Releases “Questionable Billing By Skilled Nursing Facilities” Report

Recently, the Office of Inspector General (OIG) released a report focusing on skilled nursing facilities’ (SNFs) billing practices for Medicare Part A payments. The report, “Questionable Billing By Skilled Nursing Facilities,” found that between 2006 – 2008, SNFs increasingly billed for higher paying Resource Utilization Groups (RUGs)—the classification groups of Medicare beneficiaries, based on care and resource needs—even though beneficiaries’ diagnoses at admission remained the same. It also found that for-profit SNFs were more likely than nonprofit SNFs to bill for higher paying RUGs.

The findings of the OIG report speak to the increasing medical complexity of patients receiving post-acute care in our nation’s nursing and rehabilitation facilities. A key driver of this increase in medical complexity is that these facilities are now the dominant provider of post-hospitalization services in the Medicare program. Take, for example, the findings of the 2009 Annual Quality Report:
  • In 2006, hospitals discharged approximately 4 million Medicare cases to post-acute settings, of which over 50 percent went to nursing and rehabilitation facilities.
  • From 2000 to 2006, there has been a 15 percent increase in the share of Medicare patients admitted to nursing and rehabilitation facilities. These post-hospitalization patients have a wide range of medical and rehabilitation needs.
  • The percent of nursing facility patients receiving rehabilitative care increased from 77 percent in 2003 to 81 percent in 2005 and to 87 percent in 2007.
According to the 2010 report, over 50 percent of Medicare patients treated in nursing facilities have a “major extreme severity of illness,” and nursing facilities provide care to these patients in the lowest-cost institutional setting. In addition, since 2003, there has been an annual increase in the percentage of Medicare beneficiaries discharged to the community in 100 days.

Because the patient population consists of more medically complex patients, their care is placed in a higher RUG designation. Moving forward into 2011, AHCA/NCAL will continue to work cooperatively with providers, lawmakers and the regulatory community to ensure that positive trends, like increasing the number of patients that return home, continue to advance.


DayBreak Ventures said...

Interesting that MRU’s are restricted in who they can admit for their “entensive ” services, leaving many complex pts relying in SNF’s. Now after that shift for joint pts and the like, we are questioned on the efficacy of treatment regimes in SNFs.
Skilled Nursing Care Facility Karnes

Unknown said...

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It is important to look into the excellent of proper care these houses offer. The main purpose of nursing facilities is to offer a relaxed place for the older people to remain.

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