Industry Insights

CMS Approves RAC Reviews Based on SNF PUF Data

March 2016
Author:  Sherri Robbins

Sherri Robbins

Senior Managing Consultant

Consulting

Health Care

910 E. St. Louis Street, Suite 200
P.O. Box 1190
Springfield, MO 65801-1190 (65806)

Springfield
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Providers should be aware that the Centers for Medicare & Medicaid Services (CMS) has released the updated Skilled Nursing Facility Utilization and Payment Public Use File (SNF PUF) to demonstrate its commitment to greater data transparency.

In addition to information on payments and charges, the file included information on the Very High (RV) and Ultra-High (RU) Rehabilitation Resource Utilization Groups (RUGs). The data includes the percentage of those assessments that are within 10 minutes of the minimum threshold used to classify a patient into that particular RUG group. Findings from the data include:

  • 51 percent of all RV assessments provided therapy minutes of 500 to 510
  • 65 percent of all RU assessments provided therapy minutes of 720 to 730
  • 88 providers showed 100 percent of their RV assessments with therapy minutes of 500 to 510
  • 215 providers showed 100 percent of their RU assessments with therapy minutes of 720 to 730

Overall, more than one in five providers had more than 75 percent of both RV and RU assessments that showed therapy provided within 10 minutes of the minimum threshold for the RUG level.

CMS now has given the Medicare Fee-for-Service Recovery Audit Contractors (RACs) the approval to investigate this issue.

It remains critical that SNF providers actively participate in the planning and delivery of all skilled services. Administrators, owners and nursing administration must remain vigilant to ensure documentation supports each RUG calculated for Medicare claims. Be sure to review the entire CMS fact sheet for more information.

If you have questions, please contact your BKD advisor.

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