Nursing Homes – It Is All About Case Mix

Based on latest filed Medicare cost reports, a little over 12 percent of all skilled nursing facility or “SNF” patients are Medicare recipients. This is excluding Medicare Advantage patients.  By comparison, over 57 percent of patient days were for Medicaid patients. 

It is critical to understand that Medicare pays two to three times more Medicaid per patient day for patients in SNFs. 

A SNF that has the same overall census will often go bankrupt if the percentage of Medicare patients shifts and the SNF fills empty beds with Medicaid patients. 

I worked with a SNF chain a few years back.  For many internal reasons, the number of Medicare patients fell and the SNF administrators filled the beds with Medicaid patients.  On paper, the patient census remained constant, but the chain teetered on bankruptcy.

In the current COVID0-19 world, I worry that the Medicare SNF patients will plummet as patients forgo knee and hip replacement surgery and avoid going to the acute care hospital for procedures that drive cardiac procedures requiring rehabilitation services. 

From a numbers prospective, Medicare cost report filing requirements have been delayed such that SNFs normally required to file in May now have until the end of August to file cost reports. 

I hope that SNFs can hold out that long.  In the interim, we can push to have Medicare raise reimbursement rates.  The fall in Medicare census resulting from COVID-19 could allow Medicare to make emergency rate increases while not driving up total payments to SNFs. 

Compounding these problems, we have an election looming and politicians usually like to wait to avoid fallout from proposing regulations.  I hope SNFs can hold out that long.   

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

This Leap Year, celebrate success with a 29% discount one day ONLY! Use code LEAP24 on February 29th at checkout to unlock this offer! Click here to learn more.
It’s Heart Month! Use code HEART24 at checkout to receive 20% off your cardiology products. Click here to view our suite of Cardiology products!