Long-Term Care

OIG releases Work Plan for FY 2015

MDS 3.0 Insider, November 7, 2014

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The Office of Inspector General (OIG) Work Plan for Fiscal Year (FY) 2015 provides brief descriptions of activities that the OIG plans to initiate or continue in FY 2015.  The following key items are addressed in the FY 2015 work plan for Nursing Homes.
Medicare Part A billing by skilled nursing facilities
OIG will describe changes in SNF billing practices from FYs 2011 to 2013.  Prior OIG work found that SNFs increasingly billed for the highest level of therapy even though beneficiary characteristics remained largely unchanged.  OIG also found that SNFs billed one-quarter of all 2009 claims in error; this erroneous billing resulted in $1.5 billion in inappropriate Medicare payments.  CMS has made substantial changes to how SNFs bill for services for Medicare Part A stays.
Questionable billing patterns for Part B services during nursing home stays
OIG will identify questionable billing patterns associated with nursing homes and Medicare providers for Part B services provided to nursing home residents during stays not paid under Part A (for example, stays during which benefits are exhausted or the 3-day prior-inpatient-stay requirement is not met).  A series of studies will examine several broad categories of services such as foot care.  Congress directed OIG to monitor Part B billing for abuse during non-Part A stays to ensure that no excessive services are provided.
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