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HHS finds $1.5 billion in bad billing by SNFs


By Paul Barr
Posted: November 13, 2012 - 12:30 pm ET
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(This article has been updated with a correction.)

Skilled-nursing facilities received $1.5 billion in inappropriate Medicare payments in 2009, according to HHS' inspector general's office, which found that one quarter of all SNF claims in the period were done in error. The report could lead to increased scrutiny of SNFs by Medicare administrative contractors.

The majority of the identified incorrect claims were upcoding errors, with many of the claims related to what is known as ultrahigh therapy, according to the report from the inspector general (PDF).

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As a result of the problems found with SNF billing for resource utilization groups, the inspector general recommends that the CMS: increase and expand SNF claims reviews; use its fraud prevention system to identify SNFs that are billing for higher paying RUGs; monitor compliance with new therapy assessments; change the current method for determining how much therapy is needed to ensure appropriate payments; improve the accuracy of SNF reporting; and follow up with SNFs that billed in error, according to the report.

The CMS concurred with all six recommendations and will issue a letter to Medicare administrative contractors with a copy of the report, and will also ask the MACs to focus on common errors should they increase their reviews of SNFs, according to the report.


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