Billing, Five-star quality rating system, News, Skilled Nursing Facility

CMS releases Skilled Nursing Facility utilization and payment data

On March 9th, the Centers for Medicare & Medicaid Services (CMS) released a public data set that provides information on services provided to Medicare beneficiaries by skilled nursing facilities (SNFs).  The Skilled Nursing Facility Utilization and Payment Public Use File (SNF PUF) contains information on utilization, payments, and submitted charges organized by provider, state, and resource utilization group (RUG).  The data looked at information from over 15,000 skilled nursing facilities, with over 2.5 million stays, and almost $27 billion in Medicare payments for 2013.

In addition to information on payments and charges, the SNF PUF contains information on two categories of RUGs for patients who receive a significant amount of therapy: Ultra-High (RU) and Very High (RV) Rehabilitation RUGs. CMS has found in the past that the amount of therapy provided for these two RUGS is often very close to the minimum amount of minutes needed to qualify a patient for these categories.  Medicare SNF per diem payment amounts for rehabilitation RUGs are primarily based on therapy minutes and payment amounts for these two RUGs can exceed payments for comparable RUGs with fewer therapy minutes by more than 25 percent.

CMS is hoping to bring real change through data transparency that ensures patient need, instead of payment incentives, will drive therapy services. To view a fact sheet on the Skilled Nursing Facility data set, click here.