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OIG Recommends Crack Down on Nursing Home Therapy

Wed, 11/22/2000 - 12:00am — Karen Stevenson
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The Office of the Inspector General (OIG) conducted a review of the way that nursing homes bill for Medicare Part B therapy services, and concluded that the Health Care Financing Administration (HCFA) needs to crack down on therapy billing procedures in nursing homes. The OIG found that about 22% of Part B therapy billing by nursing homes was either unnecessary, undocumented, or provided by unqualified staff in 1998, prior to the implementation of $1,500 caps on therapy charges. They also noted a significant decrease in therapy billings after the caps were implemented in 1999. The OIG stated that this decrease could have meant that patients were not getting the therapy they should have received, but that it appeared that the decrease was primarily due to changes in the way that nursing homes handled therapy. They found that most nursing homes continued to provide therapy, but did it by using non-professional nursing home staff rather than outside therapists. Their conclusion was that prior billings included unnecessary and overly-expensive therapy costs.

The OIG has concluded that the removal of the $1,500 caps on Part B therapy costs for the year 2000 is likely to lead to a return to overpayments for therapy costs in 2000 and 2001, and urged HCFA to immediately ensure that fiscal intermediaries conduct adequate focused medical reviews of Part B therapy in SNFs and continue to work to improve SNFs? and therapy providers? understanding of proper billing procedures and the medical necessity guidelines for Part B therapy in SNFs.

The Office of the Inspector General (OIG) conducted a review of the way that nursing homes bill for Medicare Part B therapy services, and concluded that the Health Care Financing Administration (HCFA) needs to crack down on therapy billing procedures in nursing homes. The OIG found that about 22% of Part B therapy billing by nursing homes was either unnecessary, undocumented, or provided by unqualified staff in 1998, prior to the implementation of $1,500 caps on therapy charges. They also noted a significant decrease in therapy billings after the caps were implemented in 1999. The OIG stated that this decrease could have meant that patients were not getting the therapy they should have received, but that it appeared that the decrease was primarily due to changes in the way that nursing homes handled therapy. They found that most nursing homes continued to provide therapy, but did it by using non-professional nursing home staff rather than outside therapists. Their conclusion was that prior billings included unnecessary and overly-expensive therapy costs.

The OIG has concluded that the removal of the $1,500 caps on Part B therapy costs for the year 2000 is likely to lead to a return to overpayments for therapy costs in 2000 and 2001, and urged HCFA to immediately ensure that fiscal intermediaries conduct adequate focused medical reviews of Part B therapy in SNFs and continue to work to improve SNFs? and therapy providers? understanding of proper billing procedures and the medical necessity guidelines for Part B therapy in SNFs.