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HomeMedicare Dispatch → OIG Calls for CMS to Reform Payment for Skilled Nursing Facility Services

OIG Calls for CMS to Reform Payment for Skilled Nursing Facility Services Print E-mail
Written by MWE.com   
Wednesday, 07 October 2015 15:55

The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) issued a report on September 30, 2015, that calls for the Centers for Medicare and Medicaid Services (CMS) to reform payment for skilled nursing facility (SNF) services. The OIG focused on billing for therapy (e.g., speech, occupational, physical) as a driver increasing SNF revenue and noted that SNFs' margin on Medicare reimbursement for therapy was 29 percent. 

Medicare pays SNFs a daily rate for therapy that is primarily based on the level of therapy provided to the beneficiary. The OIG's review of therapy billings indicated that a disproportionate number of beneficiaries received 720 minutes of therapy during the relevant seven-day assessment period-exactly the number of minutes required for "ultra-high" categorization, which results in a higher level of resource utilization group, which in turn results in higher reimbursement.

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