For CMS and its stakeholders, 2015 was marked by two momentous developments. The first was the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which repealed the flawed Sustainable Growth Rate formula and set the stage for Medicare Part B rate increases through 2019. The second was the 50th anniversary of the Medicare and Medicaid programs.
Beyond these continuumwide milestones, 2015 saw in a number of targeted regulatory initiatives to advance CMS’ goal of providing effective, patient-centered care to all of its beneficiaries.
Last month, the Department of Justice and CMS announced a $125 million settlement with RehabCare, a subsidiary of Kindred Healthcare, over improper Medicare billing. Allegations leveled at RehabCare ran the gamut of pecuniary faults: setting unrealistic financial goals for therapists, denying discontinuation of patients’ services after therapists recommended discharge, over-treating, and upcoding.
The New Year’s dust (or confetti, as the case may be) has settled, routine is restored, and the bulk of 2016 stretches ahead. For SNF billers, there’s no better time to take stock of last year’s myriad industry developments, applying lessons learned to current approaches and future plans. To fuel this reflection, BALTC asked a few experts to share their billing predictions, focuses, and advice for 2016.
The SNF improper payment rate increased 60% in 2015, potentially setting up increased auditing targeting documentation and therapy billing.
SNF improper payments rose from 6.94% in 2014 to more than 11% in 2015, according to the U.S. Department of Health and Human Services’ (HHS) Fiscal Year 2015 Agency Financial Report. According to HHS, improper payments were frequently tied to insufficient documentation for therapy services.