Medicare Program--Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities

OGC-98-50: Published: May 27, 1998. Publicly Released: May 27, 1998.


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Pursuant to a legislative requirement, GAO reviewed the Health Care Financing Administration's (HCFA) new rule on Medicare's prospective payment system and consolidated billing for skilled nursing facilities. GAO noted that: (1) the rule would implement provisions of the Balanced Budget Act of 1997 related to Medicare payment for skilled nursing facility services; (2) these provisions would include the implementation of a Medicare prospective payment system for skilled nursing facilities, consolidated billing, and a number of related changes; (3) the retrospective payment system described in the rule replaces the retrospective reasonable cost-based system currently utilized by Medicare for payment of skilled nursing facility services under Part A of the program; and (4) HCFA complied with applicable requirements in promulgating the rule.

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