Medicare May Scrutinize SNFs for Minimum Therapy Amounts in High-Use Categories Skilled nursing facilities (SNFs) may come under greater scrutiny from Medicare billing contractors if many patients in the highest revenue-generating therapy levels receive the minimum amount of therapy minutes for those levels, according to a report released by the Centers for Medicare and Medicaid Services (CMS). The Skilled Nursing Facility ... News in Brief
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News in Brief  |   May 01, 2016
Medicare May Scrutinize SNFs for Minimum Therapy Amounts in High-Use Categories
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Practice Management / News in Brief
News in Brief   |   May 01, 2016
Medicare May Scrutinize SNFs for Minimum Therapy Amounts in High-Use Categories
The ASHA Leader, May 2016, Vol. 21, 9. doi:10.1044/leader.NIB3.21052016.9
The ASHA Leader, May 2016, Vol. 21, 9. doi:10.1044/leader.NIB3.21052016.9
Skilled nursing facilities (SNFs) may come under greater scrutiny from Medicare billing contractors if many patients in the highest revenue-generating therapy levels receive the minimum amount of therapy minutes for those levels, according to a report released by the Centers for Medicare and Medicaid Services (CMS).
The Skilled Nursing Facility Utilization and Payment Public Use File includes data from 2013 on 15,055 skilled nursing facilities, more than 2.5 million stays, and almost $27 billion in Medicare payments.
Medicare per-diem payment for each SNF patient is based, in large part, on the number of therapy (speech-language, occupational and physical) minutes the patient receives. Patients in the “ultra-high” category must receive at least 720 minutes each week; those in the “very high” level must receive at least 500 minutes. The report notes that therapy at these levels can boost Medicare payments by as much as 25 percent.
SNFs have come under fire for allegedly providing significant amounts of speech-language treatment, occupational therapy and physical therapy merely to push patients into those levels rather than because the patients need the services. The U.S. Department of Justice has filed—and settled—a number of fraud complaints against SNFs that include allegations of artificially boosting patients’ therapy levels to qualify for the higher reimbursement levels.
In one of those settlements, RehabCare—the nation’s largest rehabilitation therapy company—recently paid $125 million to settle a complaint that alleged, among other things, that RehabCare presumptively placed patients in the highest therapy reimbursement levels rather than individually evaluating each patient to determine the appropriate level of care.
The SNF’s reimbursement level is the same for any number of minutes within a given category. For example, the SNF receives the same per-diem rate for a patient who receives 500 minutes or 700 minutes, as both are in the “very high” category. A large number of patients receiving close to the minimum level for each category (within 10 minutes) indicates that a SNF may be pushing patients into higher categories unnecessarily.
Consistent with prior CMS findings, the most recent report showed that for the two highest reimbursement levels, SNFs often provide therapy within 10 minutes of the category minimum. It found:
  • 51 percent of all “very high” SNF patients received 500–510 therapy minutes. For 88 providers, all patients in this category received this minimum amount.

  • 65 percent of all “ultra-high” SNF patients received 720–730 therapy minutes. For 215 providers, all patients in this category received this minimum amount.

  • For more than 20 percent of providers, more than 75 percent of their patients in both categories were provided therapy within 10 minutes of the minimum.

To help ensure that patient need—rather than payment incentives—are driving provision of therapy services, CMS is allowing recovery auditor contractors to investigate the issue.
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May 2016
Volume 21, Issue 5