OIG scrutinizes SNFs and therapy reimbursement

The Department of Health and Human Services’ Office of Inspector General will be taking another look at skilled nursing reimbursements, therapy payments and state complaint procedures in 2017, according to the agency’s Fiscal Year 2017 Workplan.

Therapy and rehabilitation billing has been on the hotseat for several years, and the scrutiny will continue in 2017. “Previous OIG work found that SNFs are billing for higher levels of therapy than were provided or were reasonable or necessary,” the report states. “We will review the documentation at selected SNFs to determine if it meets the requirements for each particular resource utilization group.” Among OIG’s new focus points in 2017 is provider billing for hyperbaric oxygen therapy services.

Nursing homes and hospice care providers will be examined for adverse events, compliance and vulnerabilities within the payment system. OIG also will examine the state processes for investigating complaints, allegations of abuse, staff misconduct and other issues.

Topics: Clinical