Welcome to the weekend and thanks for checking in. 

We’re bringing you the news from the past week as well as providing you with a look at the week ahead. Looking ahead we have a preview of tomorrow’s edition of Monitor Mondays.

Looking Back 

The bombshell that shattered the nerves of skilled nursing facility (SNF) professionals was the news from the Centers for Medicare & Medicaid Services (CMS) last week. As reported by Timothy Powell, CMS issued a report that impacts SNFs. The agency is instructing Medicare auditors to look at SNFs to determine if they are overbilling for therapy services. Moreover, CMS is giving Recovery Auditors (RAs) approval “to investigate this issue,” the report read.

The main driver for Medicare skilled nursing home payments, according to Powell, is the resource utilization group (RUG) paid for each submitted claim. The RUG is mainly driven by the number of minutes of therapy service that have been delivered to each patient. The RUG assigned to a claim has three digits. If the first digit has an “R,” then the patient received physical, occupational, or speech therapy services. 

Moving Forward

We’re working on a special bulletin for Tuesday by Mark McDavid, president of Seagrove Rehab Consulting. McDavid, a board member at large for the National Association of Rehabilitation Providers and Agencies, will report that the notice from CMS doesn’t come as welcome news to SNF providers who are “already reeling due to the overwhelming number of Additional Development Requests (ADRs) related to patients who have exceeded the $3,700 Manual Medical Review threshold. 

Speaking of time, senior healthcare analyst Frank Cohen with DoctorsManagement, has written a briefer on time — specifically, that, since, 1992, payments to physicians for Medicare Part B have been based upon the Resource Based Relative Value Scale (RBRVS). Cohen writes that the RBRVS contains three specific components; the Work Relative Value Unit (RVU), the Practice Expense RVU and the Malpractice Expense RVU.  Each of these measure, relationally, the amount of resources consumed when a medical provider performs a given service or procedure on a beneficiary. Concludes Cohen in his piece that we’ll publish on Thursday, “In the end, the entire issue of assessed time presents a confounding paradox for medical providers. On one hand, calculating assessed time is a great way to get a handle on potential aberrant coding and billing practices and to estimate audit risk. On the other hand, the use of time, at least based on the current black-box methods employed by RUC, is not reliable enough to prove any wrong doing on behalf of the provider. But that does not stop the government from trying.”   

Time marches on. And soon we will be publishing a follow up story to New York attorney Ed Roche’s reporting on Audits: Breaking Bad in New Mexico.”

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