Skilled Nursing Facilities (SNFs) operate much like hospitals, and serve very important after-care purposes for individuals coming out of hospital care. They also provider PT, OT and ST services to get elderly individuals back on their feet. Much like DRG codes in an inpatient setting, SNFs are reimbursed through the use of Resource Utilization Groups (RUGs) which detail the expected level of service required for each patient's treatment. Based on which RUG a patient falls in, Medicare reimburses the SNF various amounts. However, due to the complexity of RUG assessment, Medicare auditors often modify the RUG which a beneficiary falls in, resulting in an alleged overpayment to the SNF.
Liles Parker has extensive experience handling these types of cases - if you have any questions about a Medicare audit involving RUGs or other issues regarding your SNF, call today for a free consultation.