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OIG says SNF billing for changes in therapy needs improvement

July 9, 2015
by Megan Combs, Associate Editor
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In fiscal years 2011 and 2012, the Centers for Medicare and Medicaid Services put new policies in place to address concerns that skilled nursing facility (SNF) billing didn't reflect the changes in the amount of therapy a person received during their stay. A new study from the Department of Health and Human Services Office of Inspector General (OIG) says improvements are still needed for that billing process.

To conduct this study, the OIG used SNF claims to analyze billing for changes in therapy from 2010 to 2013. It also examined whether SNFs used assessments any differently after CMS put its new policies in place. New CMS policies included three types of therapy assessments to determine when a patient started, ended, increased or decreased therapy. 

Research discovered that SNF billing for changes in therapy increased by a miniscule amount, and the facilities used the assessments differently when therapy decreased, compared to when therapy increased, which ended up costing Medicare $143 million over two years. 

To fix this problem, the OIG recommends that CMS accelerate its efforts to begin a new method for paying for therapy.

"A new payment method may eliminate the need for the new assessments by basing payments on beneficiary characteristics rather than on the amount of therapy provided," the OIG reported. "In the meantime, CMS should mitigate the problems with the new therapy assessments by reducing the financial incentive for SNFs to use assessments differently when decreasing and increasing therapy and (by) strengthening the oversight of SNF billing for changes in therapy."

Read the full OIG report here (PDF).

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