CMS Announces SNF Claims Will Be Scrutinized More Closely

The Centers for Medicare and Medicaid Services (CMS) published a memo concerning a crackdown on improper claims for skilled nursing facilities. CMS also announced that it would begin a demonstration for inpatient rehabilitation facilities in Alabama that will allow all Medicare claims to be subject to review.

As of June 5, all SNFs participating in Medicare Fee-for-Service will be subject to claims adjustments and denials if claims are found to be improper, according to a CMS updated memo.

The move comes after the Comprehensive Error Rate Testing (CERT) program projected an improper payment rate of over 15% for FFS in 2022 and nearly twice that of 2021. Skilled Nursing News reports that CMS will have auditors conduct reviews of five claims per SNF and providers with a more than 20% error rate will receive one-on-one education with a Medicare Area Contractor (MAC).

The American Hospital Association (AHA) voiced its opposition to a CMS demonstration in Alabama inpatient rehabilitation facilities (IRFs) that is scheduled to begin in August. IRFs will have 100% of their Medicare FFS claims subject to review for at least six months, but AHA calls it an administrative burden. From AHA Senior Vice President for Public Policy Analysis Ashley Thompson:

This demonstration threatens access to care for seriously ill and injured Medicare beneficiaries, and will further tax rehabilitation hospitals and units that are already facing critical staffing difficulties.

The timeline and updates for the Review Choice Demonstration for IRFs can be found at CMS.