The annual work plan that was recently released states that the office of Inspector General will review compliance with various aspects of the skilled nursing facility prospective payment system. The review will include the documentation requirements in support of claims paid by Medicare. Prior reviews have found that Medicare payments for therapy greatly exceeds SNF cost.  Additionally it was found that skilled nursing facilities have increasingly billed for the highest level of therapy even though key beneficiary characterization remained largely the same.

The oig  states taht it intends to ensure that skilled nursing facility care is reasonable and necessary and that SNF claims are paid in accordance with federal laws and regulations. All documentation requirements under 42 CFR section 483.20 must be met to ensure that the skilled nursing facility care is reasonable and necessary. Documentation needs to include the physician order at the time of admission for the residence immediate care, a comprehensive assessment, and the comprehensive plan of care prepared by an interdisciplinary team that includes the attending physician, a registered nurse and other appropriate staff.

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