Payments for Medicare Part B Services During Non-Part A Nursing Home Stays in 2008

We found that Medicare paid $4.9 billion in 2008 for Part B services during nursing home stays not paid for by Part A (hereinafter referred to as non-Part A stays). Three service categories, therapy services, evaluation and management, and major and minor medical procedures, made up 58 percent of the total payment. On average, Medicare paid $16.75 per day per beneficiary for Part B services across all service categories and beneficiaries. The service category of dialysis services and the State of Louisiana exhibited the highest average daily payments.

This study is part of OIG's activities to monitor Part B payments for items and services furnished to nursing home residents during non-Part A stays. We used resident assessment data from the Minimum Data Set to identify nursing home stays nationwide during 2008 and reviewed Part B claims that occurred during non-Part A stays. This report provides insights into payment and utilization patterns for Part B services, as well as geographic differences, that will guide further review and identification of providers of Part B services warranting scrutiny by OIG and CMS.