OIG report on overbilling calls SNF practices ‘questionable’

I received an e-mail this morning containing a link to a New York Times blog titled, “Report Questions Nursing Home Charges,” by Paula Span, which discusses a Health and Human Services’ Office of Inspector General report investigating how often skilled nursing facilities (SNFs) apply for maximum reimbursement for the highest RUG levels of care.

The report, “Questionable Billing by Skilled Nursing Facilities,” presents a few interesting findings:

· From 2006 to 2008, although the beneficiary profiles remained the same, the percentage of RUGs billed for ultra high-level therapy increased from 17% to 28%. Some for-profit SNFs routine billing at higher RUG levels and extend the patients stay.

· For-profit SNFs were more likely to bill for higher paying RUGs than were nonprofits and government-run SNFs.

· In 2008, a number of SNFs were identified as having questionable billing practices.

The report concluded that the current system “provides incentives to SNFs to bill for ultra high therapy and for high levels of assistance when these levels of care may not be needed.”

The report also provides recommendations to the Centers for Medicare & Medicaid Services (CMS), including more vigilant monitoring and changing the current method of determining the necessary amount of therapy required. In addition, the report recommends that CMS develop a guidance specifying the types of patients appropriate for each level of therapy—including ultra high.

Download the OIG report here.

Topics: Regulatory Compliance