Ultra High therapy billing prompts investigation, HHS/CMS (Centers of Medicare and Medicaid Services) says:

The Skilled Nursing Facility Utilization and Payment Public Use File, released Wednesday, shows Ultra High therapy billing accounted for the highest Medicare payments to SNFs, total therapy days, beneficiaries served and average Medicare payment per beneficiary in 2013.

Concerns over skilled nursing facility residents receiving the highest levels of therapy in huge amounts have driven the Centers for Medicare & Medicaid Services to turn the issue over to recovery audit contractors (RAC), CMS officials said in a new report.

Blogger comment:

The saying “statistics lie if the statistician is a liar”. The data proves in my opinion that the incentives created by the flawed RUG’s reimbursement algorithm are the reason for the obvious use of ultra high to very high minutes that creates the payment levels. If you notice the average therapy coverage period is 28 days … come on for post hospital comorbid patients. The reason for the use of higher minutes is because there isn’t enough coverage for the length of stay really needed. This has been the case for 30 years with CMS’ illegal “rules of thumb” Fox v Bowen 1986 and using the “improvement standard” Jimmo v Sebelius 2011.

CMS has ignored the directive of the Federal courts to change their illegal tactics. It has driven down the average coverage period allowed of 100 days to a period of time that doesn’t allow the typical Medicare beneficiary to be fully restored for discharge in 28 days using reasonable therapy minutes and skilled nursing days … so what we have here is CMS incriminating thousands of providers as being fraudulent and abusing the reimbursement formula when in effect CMS has created the allegations and now want to prosecute on that basis.

Not only has this harmed the providers but deprived the beneficiaries of rightful coverage and has relegated tens of thousands to become dependents on Medicaid until they expired. The court cases I site above prove that CMS ignores due process of law and 900,000 pending appeals will be rejected based on illegal interpretations by the RAC auditors who make money on those illegal premises.

If the providers don’t challenge this over reaching regulatory ploy to save money then we all will go broke and so will our bankrupt Government.