OIG to Monitor Nursing Home Practices

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 The Office of Inspector General has released its Fiscal Year 2015 Mid-Year Update which includes several initiatives may affect skilled nursing providers.

The OIG announced that they will be taking a closer look at Medicare Part A billing by skilled nursing facilities (SNFs), based on previous OIG reports that found SNFs increasingly billed for the highest level of therapy, despite beneficiary characteristics remaining largely unchanged. In addition to high billing, the OIG also found that SNFs had a 25 percent claim error rate in 2009 which resulted in $1.5 billion in erroneous Medicare payments. The OIG also announced they will review the rate of Medicaid beneficiary transfers from nursing homes to hospital emergency departments because high emergency transfer rates could be an indicator of poor quality.

The OIG also states that it will evaluate whether or not state survey agencies verified nursing home deficiency correction plans. This stems from a review that found one state survey agency did not always verify that homes corrected deficiencies found during surveys. State verification of deficiency correction plans is required by federal regulations and is completed through onsite reviews or evidence of correction.



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