Dive Brief:
- A report released this week from the HHS Office of Inspector General concludes skilled nursing facilities have increasingly been filing Medicare claims for the highest level of therapy even though the characteristics of their patients have remained largely unchanged.
- These billing increases were responsible for $1.1 billion in Medicare payments in fiscal years 2012 and 2013.
- The OIG says payment reform for skilled nursing facilities could save Medicare billions and incentivize the facilities to provide services more appropriate to patients' needs.
Dive Insight:
Acting CMS Administrator Andrew M. Slavitt agreed with the OIG's findings and the need for payment reform. He said the current system creates an incentive for nursing homes to “provide as much therapy to a resident as that resident can tolerate,” The New York Times reports.
Slavitt said in order to reduce Medicare payment rates for therapy in nursing homes, Congress would have to provide the agency with “additional statutory authority.”
Aside from the possibility of payment reform, Slavitt added, Medicare will target the issue by ramping up efforts to detect suspicious billing behavior by nursing homes.
The American Health Care Association, which represents nursing facilities, says it supports payment reform. It suggests Medicare pay a single lump sum for each patient based on their level of need, rather than paying for each day of care based partly how much therapy is provided.
