Problem
PDPM replaced the previous classification system for SNF payment due to concerns over thresholding. Thresholding is providing just enough therapy for residents to surpass the relevant therapy thresholds to achieve a higher reimbursement level. The following three reports alerted CMS to concerns about improper billing at Skilled Nursing Facilities.
1) Questionable Billing by Skilled Nursing Facilities (December 2010)
2) Inappropriate Payments to Skilled Nursing Facilities Cost Medicare More than a Billion Dollars in 2009 (November 2012)
3) The Medicare Payment System for Skilled Nursing Facilities Needs to be Reevaluated (September 2015)
Read these three reports, which investigate the concerns of improper billing. Do you believe the reports provided enough evidence to warrant a new classification system for Medicare SNF payment system?