Performance Improvement 2008. What Services Does Medicare Include Under Part B For Nursing Home Residents Who Do Not First Receive Hospital Services Under Part A?


This study examined Medicare Part B services and allowed payments for nursing home residents not in a Medicare Part A covered stay during calendar year 2002. Researchers compiled data on Medicare Part B services for nursing home residents, linking information from several databases. Researchers developed descriptive information by service and by resident on the population of nursing home residents with Part B claims.

Medicare allowed $5.3 billion for Part B services provided to nursing home residents. Payments varied by State for each of the ten categories. The ten categories included minor procedures, nursing home visit, ambulance, lab test, specialist, enteral nutrition, dialysis, durable medical equipment, standard imaging, and hospital visit. This analysis found variation in State median payments per resident among the top 10 categories of service. Variation across States may reflect differences in populations or differences in care provided, or may be an indication of inappropriate services. As a baseline review, this analysis did not determine whether variation was due to differences in care provided or due to inappropriate billing practices. Making such a determination would require further, more in-depth review.

Report Title: Medicare Part B Services for Nursing Home Residents: 2002.
Agency Sponsor:
OS-OIG, Office of Inspector General
Federal Contact: Claire Barnard, 202-205-9523
Office of Inspector General
PIC ID: 8779

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