OPEN MINDS Industry Resources

United States General Accounting Office Skilled Nursing Facilities: Services Excluded From Medicare's Daily Rate Need to be Reevaluated Results in Brief Although the service-exclusion criteria and the services removed from the daily payment rate appear reasonable, questions remain about whether certain other services should also be excluded and how to modify the exclusions over time. HCFA generally relied on three criteria in choosing services to exclude. Excluded services must be high cost, infrequently provided during a SNF stay, and not likely to be overprovided. Because SNFs have an incentive under the PPS to minimize costs that are covered . . .