CMS to Have RACs Audit SNF Therapy Utilization & Payment

May 2, 2016
Rick Gawenda

The Centers for Medicare and Medicaid Services (CMS) has released Skilled Nursing Facility (SNF) utilization and payment data for 2013. In addition to information on payments and charges, the SNF Payment Public Use File (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. Consistent with prior CMS findings, the SNF PUF shows that for these two RUGs, the amount of therapy provided 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. Due to this, CMS has referred this issue to the Recovery Auditor Contractors (RAC) for further investigation.

To view the 2013 payment data, click

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