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The Therapy Resource Utilization Groups at Epworth Villa Retirement Community's Skilled Nursing Facility Were Properly Supported

Why OIG Did This Review

Skilled Nursing Facility (SNF) claims include Resource Utilization Groups (RUGs) that identify whether a beneficiary received therapy and the range of therapy minutes provided. For example, SNF claims with a RUG that begins with "RU" or "RV" indicate that an ultra high or very high level of therapy was provided and that during a 7-day period, the beneficiary received 720 minutes or more, or 500 to 719 minutes of therapy, respectively. The higher the volume of therapy services provided, the higher the Medicare payment.

Previous OIG work found that SNFs billed for higher levels of therapy RUGs than were supported.

Our objective was to determine whether the therapy minutes associated with Epworth Villa Retirement Community's SNF claims containing ultra high or very high therapy RUGs were properly supported.

How OIG Did This Review

We selected for review the SNF at Epworth Villa, located in Oklahoma City, Oklahoma, because during a 1-year period, more than 93 percent of its RUGs were for very high or ultra high therapy, and the therapy minutes for 94 percent of those RUGS were within 10 minutes of the minimum requirement.

Our review covered $4,433,545 in Medicare payments for 710 SNF claims for services provided from July 1, 2016, through June 30, 2017.

Results of Review

We found that Epworth Villa's therapy minutes associated with ultra high and very high RUGs were properly supported. Accordingly, this report contains no recommendations.

Filed under: Centers for Medicare and Medicaid Services