2015 OIG Work Plan Highlights: Nursing Home Services

We recently highlighted the home health and hospice services sections of the 2015 OIG Work Plan. Today, we’ll delve deeper into the nursing home services section:

Medicare Part A billing by skilled nursing facilities. The OIG will describe skilled nursing facility (SNF) billing practices and the differences among SNFs in specific years. The OIG found that SNFs billed one-quarter of all 2009 claims in error, resulting in $1.5 billion in inappropriate Medicare payments. The OIG notes that CMS has made significant changes to how SNFs bill for Medicare Part A stays.

Questionable billing patterns for Part B services during nursing home stays. The OIG will identify and review questionable billing patterns of nursing homes and Medicare providers for Part B services provided to nursing home residents during stays not paid under Part A.

State agency verification of deficiency corrections.The OIG will determine whether State survey agencies verified correction plans for deficiencies identified during nursing home recertification surveys. Federal regulations require nursing homes to submit correction plans to the State survey agency or CMS for deficiencies identified during surveys.

Program for national background checks for long-term-care employees. The OIG will review the procedures implemented by participating States for long-term-care facilities or providers to conduct background checks on prospective employees and providers who would have direct access to patients.

Hospitalizations of nursing home residents for manageable and preventable conditions. The OIG will determine the extent to which Medicare beneficiaries residing in nursing homes are hospitalized as a result of conditions thought to be manageable or preventable in the nursing home setting. The OIG states hopitalizations of nursing home residents may indicate quality-of-care problems in nursing homes.

Click here to see the plan.


One thought on “2015 OIG Work Plan Highlights: Nursing Home Services

  1. Pingback: Monday Morning Recap | hmsabc

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