The Centers for Medicare & Medicaid Services (CMS) final ruling, Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) for FY 2012, has many personnel at SNFs concerned about the future of patient care.
CMS announced a net cut of 11.1 percent, or $3.87 billion, to Medicare SNF reimbursement in fiscal year 2012. This payment reduction is due to the unintended increase in overall payment levels under the new Resource Utilization Group Version 4 (RUG-IV) system, which became effective October 1, 2010. Reports show providers were billing at nearly four times the projected rate for services in the higher-cost therapy classifications, prompting CMS to reduce payment levels to better align Medicare payments with costs. The July 29, 2011, final rule lowers SNF therapy reimbursement rates to restore Medicare payments to their intended levels.
The final rule also implements certain changes relating to the definition and payment for group therapy services. The ruling defines group therapy as services provided to four patients who are performing similar therapy activities. Payments for group therapy services will be allocated among the four-group therapy participants to more accurately reflect resource utilization and costs.
If you would like more information regarding reimbursement changes, please contact the experts listed below at PYA, (800) 270-9629.
