Creator: Patrick Connole
MedPAC Sleuths Hot on SNF PPS Payment Trail
MedPAC wants to know if AI and other factors are distorting resident selection for SNFs and separately, if coding distortions and inaccurate payments are occurring.
The Medicare Payment Advisory Commission (MedPAC) last week at its regular monthly meeting said it would undertake an investigation of potential coding distortions, inaccurate payments, and the role of financial incentives in patient selection for nursing home providers.
The investigation is under the umbrella of a larger assessment of payment accuracy in FFS Medicare in the SNF and home health payment systems.
Commissioners are specifically concerned about the role AI is playing in the practices of health systems and providers when it comes to coding intensity and reporting patient acuity as a lever to boost revenue.
“Do the SNF and home health PPSs accurately account for differences in patient costs?” the commission staff asked in their presentation. “Is there evidence providers select certain types of cases over others? Is there evidence providers’ coding practices have raised payments without commensurate changes in patient complexity?”
MedPAC said the investigation will encompass the years 2021–2025. A draft report will be issued in the fall of 2027.
The slides for this presentation are here.
Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.
