According to the Centers for Medicare & Medicaid Services (CMS), a primary cause of improper Medicare payments to skilled nursing facilities (SNFs) is the submission of incorrect certification and recertification statements to Medicare. SNFs must complete these documents accurately to avoid disputes over payment, and thereby continue generating the revenue necessary to provide quality care for their residents. While interest rates remain low, skilled nursing facilities and other senior housing providers interested in obtaining capital for debt refinancing should contact the Chicago-based financing firm Cambridge Realty Capital to learn about the different financing programs it offers for senior housing transactions.

According to a recently published CMS memo, between 2012 and 2013, the improper payment rate for skilled nursing facilities increased from 4.8 percent to 7.7 percent. The increase was partly due to failures by SNFs to submit correct certification and recertification statements to Medicare. In an effort to address this, the memo reminds SNFs of the information required for complete these documents. For example, a proper certification statement must state that the resident needs skilled nursing care or skilled rehabilitation services for a condition they received while in inpatient care. A physician or non-physician practitioner must then sign and date the certification statement.

A recertification statement must state the purpose of the resident’s post-hospital care, and provide an estimate of how long they will need to remain in the skilled nursing facility. It must include any plans the resident made for home health care, and it must state whether the resident’s ongoing need for care services is due to a condition that arose after being admitted to the skilled nursing facility. A physician or non-physician practitioner must then sign and date the recertification statement.

The CMS memo also provides examples of some common errors made by SNFs when submitting these statements. Some certifications simply state that the “resident certified as skilled (Medicare),” but exclude information on the resident’s need for daily care, or that the purpose is to treat an ongoing condition previously treated in an inpatient setting. Some recertification statements fail to reference the previous certification or point out instances where the service dates do not correspond to those given in previous certification statements.

Some errors leading to improper payments are relatively minor and easily preventable. Skilled nursing facilities should consider implementing review procedures in order to catch any errors before submitting the documents to Medicare. This will help reduce improper payments and Medicare disputes that may potentially disrupt the finances of a skilled nursing facility.

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