CMS Improper Payment Probe May Impact Timely Reimbursement for Nursing Homes

All skilled nursing facilities that participate in Medicare Fee-for-Service (FFS) can expect a letter from the Centers for Medicare & Medicaid Services (CMS) regarding improper payment rates starting June 5.And, as of an updated memo from CMS on Monday, claims could be adjusted or denied if an improper payment is identified. CMS initially posted publicly about the decision on May 4, then briefly made the information confidential last week.The move is in reaction to data compiled using the Comprehensive Error Rate Testing (CERT) program, which projected an improper payment rate of 15.1% in 2022 for FFS – nearly double compared to 7.79% in 2021.

Medigy Insights

The ongoing CMS improper payment probe has the potential to impact the timely reimbursement for nursing homes. As CMS investigates potential instances of improper payments, nursing homes may experience delays in receiving reimbursement for services provided. To mitigate the impact, nursing homes should proactively review their billing practices, ensure accurate documentation, and align their operations with CMS guidelines to minimize the risk of improper payments. Maintaining strong communication and collaboration with CMS and implementing robust internal controls can help mitigate delays in reimbursement and ensure financial stability for nursing homes. By addressing any identified issues and demonstrating compliance with CMS regulations, nursing homes can strive to maintain a steady flow of timely reimbursements for the services they provide.

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