August 30, [Contact Name] SNF Name, [Address Line 1] [Address Line 2] [City], B8 [ZIP]

Transcription

1 Bridgepoint 1, Suite West Courtyard Drive, Austin TX August 30, 2013 [Contact Name] SNF Name, [Address Line 1] [Address Line 2] [City], B8 [ZIP] RE: Program for Evaluating Payment Patterns Electronic Report (PEPPER) Dear Chief Executive Officer/Administrator, The Centers for Medicare & Medicaid Services (CMS) is pleased to provide this provider-specific comparative data report, known as PEPPER, for Skilled Nursing Facilities (SNFs). PEPPER can be used to support internal auditing and monitoring activities with the goal of preventing improper Medicare payments and protecting the Medicare Trust Fund. CMS has contracted with TMF Health Quality Institute to develop and distribute PEPPER and to support facilities with its use. Please share your SNF PEPPER with those in your organization who would most benefit from the data provided in the report. What is PEPPER? It is a report containing provider-specific data statistics for episodes of care identified as potentially vulnerable to improper Medicare payments. It identifies where the SNF is at greatest risk for improper payments as compared to all other SNFs in the nation. This is SNF PEPPER version Q4FY12, containing statistics for episodes of care ending between October 1, 2009 through September 30, Interpreting PEPPER: SNFs are encouraged to review the reports and focus on areas in which they are an outlier, meaning they are at greatest risk for improper payments (at or above the 80th percentile, or at or below the 20th percentile for areas at risk for undercoding). PEPPER cannot identify the presence of improper payments. These can only be confirmed through a review of medical record documentation, although outlier status identifies where billing practices differ from the majority of other SNFs in the nation. Training and Support: At PEPPERresources.org, access the SNF PEPPER User s Guide and a recorded SNF PEPPER training session, located on the Training and Resources page in the Skilled Nursing Facility section. Questions regarding the SNF PEPPER may be submitted at any time through the website Help Desk (Help/Contact Us tab). Sincerely, Kimberly Hrehor, MHA, RHIA, CHC Project Director

2 Definitions for Skilled Nursing Facility (SNF) PEPPER Target Areas SNF Target Area Therapy s With High ADLs (Therapy Hi ADL) SNF Target Area Definition Numerator (N): count of days billed within episodes of care ending in the report period with equal to RUX (Rehabilitation ultra high & extensive services w/ ADL (16-18 in version III)), RVX (Rehabilitation very high & extensive services w/ ADL (16-18 in version III)), RHX (Rehabilitation high & extensive services w/ ADL (16-18 in version III)), RMX (Rehabilitation medium & extensive services w/ ADL (16-18 in version III)), RUC (Rehabilitation ultra high w/ ADL (16-18 in version III)), RVC (Rehabilitation very high w/ ADL (16-18 in version III)), RHC (Rehabilitation high w/ ADL (16-18 in version III)), RMC (Rehabilitation medium w/ ADL (16-18 in version III)), RLB (Rehabilitation low with ADL (16-18 in version III)) Denominator (D): count of days billed within episodes of care ending in the report period for all therapy s (see Appendix 1 in Skilled Nursing Facility PEPPER User's Guide) Nontherapy s With High ADLs (Nontherapy Hi ADL) Note: An episode of care is defined as a series of claims from a SNF for a beneficiary where the difference between the Through Date of one claim and the From Date of the subsequent claim is less than or equal to thirty days. The From and Through dates in form locator 6 (statement covers period) on the claim identify the span of service dates included in a particular bill; the From date is the earliest date of service on the claim. N: count of days billed within episodes of care ending in the report period with equal to SSC (Special care w/ ADL 17-18), CC2 (Clinically complex w/ depression & ADL 17-18), CC1 (Clinically complex w/o depression & ADL 17-18), BB2 (Behavioral w/ 2+ restorative nursing & ADL 6-10), BB1 (Behavioral w/ <=1 restorative nursing & ADL 6-10), PE2 (Physical function w/ 2+ restorative nursing & ADL 16-18), PE1 (Physical function w/ <=1 restorative nursing & ADL 16-18), IB2 (Impaired cognition w/ 2+ restorative nursing & ADL 6-10), IB1 (Impaired cognition w/ <=1 restorative nursing & ADL 6-10) in III; HE2 (Special care high w/ depression & ADL 15-16), HE1 (Special care high w/o depression & ADL 15-16), LE2 (Special care low w/ depression & ADL 15-16), LE1 (Special care low w/o depression & ADL 15-16), CE2 (Clinically complex w/ depression & ADL 15-16), CE1 (Clinically complex w/o depression & ADL 15-16), BB2 (Behavior/cognitive w/ 2+ restorative nursing & ADL 2-5), BB1 (Behavior/cognitive w/ <=1 restorative nursing & ADL 2-5), PE2 (Physical function w/ 2+ restorative nursing & ADL 11-14), PE1 (Physical function w/ <=1 restorative nursing & ADL 15-16) in IV Change of Therapy Assessment (COT Assmnt) Ultrahigh Therapy s (Ultrahigh) D: count of days billed within episodes of care ending in the report period for all nontherapy s (see Appendix 2 in SNF PEPPER User's Guide) N: count of assessments with AI second digit equal to D within episodes of care ending in the report period D: count of all assessments within episodes of care ending in the report period N: count of days billed within episodes of care ending in the report period with equal to RUX, RUL (Rehabilitation ultra high & extensive services w/ ADL 2-10 (9-15 in version III)), RUC, RUB (Rehabilitation ultra high w/ ADL 6-10 (9-15 in version III)), RUA (Rehabilitation ultra high w/ ADL 0-5 (4-8 in version III)) Therapy s (Therapy) 90+ Day Episodes of Care (90+ Days) D: count of days billed within episodes of care ending in the report period for all therapy s (see Appendix 1 in Skilled Nursing Facility PEPPER User's Guide) N: count of days billed within episodes of care ending in the report period for therapy s (see Appendix 1 in Skilled Nursing Facility PEPPER User's Guide) D: count of days billed within episodes of care ending in the report period for therapy and nontherapy s (see Appendices 1 and 2 in Skilled Nursing Facility PEPPER User's Guide) N: count of episodes of care ending in the report period with a length of stay of 90+ days D: count of all episodes of care ending in the report period Worksheet: Definitions Page: 2

3 Skilled Nursing Facility PEPPER Compare Targets Report, Four Quarters Ending Q4 FY 2012 The Compare Targets Report displays statistics for target areas that have reportable data (11+ target numerator count) in the most recent time period. Percentiles indicate how a Skilled Nursing Facility's (SNFs) target area percent compares to the target area percents for all SNFs in the respective comparison group. For example, if a SNF's national percentile (see below) is 80.0, 80% of the SNFs in the nation have a lower percent value than that SNF. The SNF's state percentile (if displayed) and the Medicare Administrative Contractor (MAC) jurisdiction percentile values should be interpreted in the same manner. Percentiles at or above the 80th percentile for any target areas, or at or below the 20th percentile for areas at risk for undercoding, indicate that the SNF may be at a higher risk for improper Medicare payments. The greater (or smaller, for areas at risk for undercoding) the percentile value, in particular the national and/or jurisdiction percentile, the greater consideration should be given to that target area. Target Therapy High ADL Nontherapy High ADL Change of Therapy Assessment Ultrahigh Therapy s Therapy s 90+ Day Episodes of Care Description Proportion of days billed within episodes of care ending in the report period with equal to RUX, RVX, RHX, RMX, RUC, RVC, RHC, RMC, RLB, to days billed within episodes of care ending in the report period for all therapy s Proportion of days billed within episodes of care ending in the report period with equal to SSC, CC2, CC1, BB2, BB1, PE2, PE1, IB2, IB1 in III; HE2, HE1, LE2, LE1, CE2, CE1, BB2, BB1, PE2, PE1 in IV, to days billed within episodes of care ending in the report period for all nontherapy s Proportion of assessments with AI second digit equal to D within episodes of care ending in the report period, to all assessments within episodes of care ending in the report period Proportion of days billed within episodes of care ending in the report period with equal to RUX, RUL, RUC, RUB, RUA, to days billed within episodes of care ending in the report period for all therapy s Proportion of days billed within episodes of care ending in the report period for therapy s, to days billed within episodes of care ending in the report period for all therapy and nontherapy s Proportion of episodes of care ending in the report period at the SNF with a length of stay of 90+ days, to all episodes of care ending in the report period at the SNF Target Count Percent SNF National %ile SNF State %ile SNF Jursidict. %ile 2, % , % % , % , % % Note: State and Jurisdiction %tiles are not reported when there are fewer than 11 SNFs Worksheet: Compare or when there are no SNFs with at least 11 target episodes of care. Page: 3

4 Need to audit? When reviewing this information, you may want to consider auditing a sample of records if you identify: Increasing or decreasing Target Percents over time resulting in outlier status Your Target Percent (first row in the table below) is above the national 80th percentile Your Target Percent is below the national 20th percentile Therapy s With High ADLs Target Percent 70% 60% 50% 40% 30% 20% 10% 0% 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 SNF Juris: 80th %ile State: 80th %ile Natl: 80th %ile Juris: 20th %ile State: 20th %ile Natl: 20th %ile YOUR SNF 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 Target Area Percent 44.7% 38.8% 35.9% Target Count (Numerator: see Definitions worksheet) 3,351 2,299 2,481 Denominator Count (see Definitions worksheet) 7,489 5,930 6,904 Target (Numerator) Average Length of Stay Denominator Average Length of Stay *Data not available when target count less than 11. COMPARATIVE DATA Note: State Percentiles are zero when there are fewer than 11 SNFs in the jurisdiction's state or when there are no SNFs with at least 11 target discharges. National 80th Percentile 52.5% 46.3% 47.6% Jurisdiction 80th Percentile 56.4% 48.1% 49.3% State 80th Percentile 57.8% 48.2% 49.3% National 20th Percentile 21.8% 18.3% 19.2% Jurisdiction 20th Percentile 28.4% 22.7% 22.8% State 20th Percentile 29.0% 23.0% 23.3% SUGGESTED INTERVENTIONS FOR HIGH OUTLIERS: This could indicate a risk of potential overcoding of beneficiaries' activities of daily living (ADL) status. The SNF should determine whether the amount of assistance beneficiaries need with ADLs as reported on the MDS is supported and consistent with medical record documentation. SUGGESTED INTERVENTIONS FOR LOW OUTLIERS: This could indicate a risk of potential undercoding of beneficiaries' ADL status. The SNF should determine whether the amount of assistance beneficiaries need with ADLs as reported on the MDS is supported and consistent with medical record documentation.

5 Need to audit? When reviewing this information, you may want to consider auditing a sample of records if you identify: Nontherapy s With High ADLs 60% 50% Increasing or decreasing Target Percents over time resulting in outlier status Your Target Percent (first row in the table below) is above the national 80th percentile Your Target Percent is below the national 20th percentile Target Percent 40% 30% 20% 10% 0% 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 SNF Juris: 80th %ile State: 80th %ile Natl: 80th %ile Juris: 20th %ile State: 20th %ile Natl: 20th %ile YOUR SNF 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 Target Area Percent 15.1% 18.8% 44.4% Target Count (Numerator: see Definitions worksheet) ,485 Denominator Count (see Definitions worksheet) 2,790 2,889 3,345 Target (Numerator) Average Length of Stay Denominator Average Length of Stay *Data not available when target count less than 11. COMPARATIVE DATA Note: State Percentiles are zero when there are fewer than 11 SNFs in the jurisdiction's state or when there are no SNFs with at least 11 target discharges. National 80th Percentile 36.2% 36.3% 40.7% Jurisdiction 80th Percentile 34.0% 40.9% 46.5% State 80th Percentile 36.7% 46.0% 50.8% National 20th Percentile 10.2% 9.9% 11.2% Jurisdiction 20th Percentile 9.6% 11.7% 14.8% State 20th Percentile 10.5% 13.3% 16.5% SUGGESTED INTERVENTIONS FOR HIGH OUTLIERS: This could indicate a risk of potential overcoding of beneficiaries' activities of daily living (ADL) status. The SNF should determine whether the amount of assistance beneficiaries need with ADLs as reported on the MDS is supported and consistent with medical record documentation. SUGGESTED INTERVENTIONS FOR LOW OUTLIERS: This could indicate a risk of potential undercoding of beneficiaries' ADL status. The SNF should determine whether the amount of assistance beneficiaries need with ADLs as reported on the MDS is supported and consistent with medical record documentation.

6 Need to audit? When reviewing this information, you may want to consider auditing a sample of records if you identify: Change of Therapy Assessment 18% 16% 14% Increasing Target Percents over time resulting in outlier status Your Target Percent (first row in the table below) is above the national 80th percentile Target Percent 12% 10% 8% 6% 4% 2% 0% 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 SNF Natl: 80th %ile Juris: 80th %ile State: 80th %ile YOUR SNF 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 Target Area Percent 4.1% Target Count (Numerator: count of assessments with AI second digit equal to D within episodes of care ending in the report period) Note: the COT Assessment became 41 Denominator Count (count of all assessments within episodes of care ending in the report period) effective Oct. 1, 2011; statistics are not available for FYs 2010 and ,004 *Data not available when target count less than 11. COMPARATIVE DATA Note: State Percentiles are zero when there are fewer than 11 SNFs in the jurisdiction's state or when there are no SNFs with at least 11 target discharges. National 80th Percentile 17.0% Jurisdiction 80th Percentile 14.3% State 80th Percentile 0.0% 13.4% SUGGESTED INTERVENTIONS FOR HIGH OUTLIERS: This could indicate that the SNF is experiencing challenges with delivering services to the beneficiary as anticipated. The SNF may look into factors that lead to the need for the COT assessment (e.g., can care planning be improved? Are there issues with completing therapy as scheduled?) Note: SNFs that are using the COT assessment infrequently or not at all may be targeted by MACs or RACs for review to establish whether therapy assessments are being completed as required (see page 15).

7 Need to audit? When reviewing this information, you may want to consider auditing a sample of records if you identify: Ultrahigh Therapy s 90% 80% 70% Increasing Target Percents over time resulting in outlier status Your Target Percent (first row in the table below) is above the national 80th percentile Target Percent 60% 50% 40% 30% 20% 10% 0% 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 SNF Natl: 80th %ile Juris: 80th %ile State: 80th %ile YOUR SNF 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 Target Area Percent 33.6% 44.1% 85.6% Target Count (Numerator: count of days billed within episodes of care ending in the report period with equal to RUX, RUL (Rehabilitation ultra high & extensive services w/ ADL 2-10 (9-15 in version III)), RUC, RUB (Rehabilitation ultra high w/ ADL 6-10 (9-15 in version III)), RUA (Rehabilitation ultra high w/ ADL 0-5 (4-8 in version III)) 2,518 2,614 5,911 Denominator Count (count of days billed within episodes of care ending in the report period for all therapy s (see Appendix 1in Skilled Nursing Facility PEPPER User's Guide)) 7,489 5,930 6,904 Target (Numerator) Average Length of Stay Denominator Average Length of Stay *Data not available when target count less than 11. COMPARATIVE DATA Note: State Percentiles are zero when there are fewer than 11 SNFs in the jurisdiction's state or when there are no SNFs with at least 11 target discharges. National 80th Percentile 65.1% 67.7% 69.2% Jurisdiction 80th Percentile 54.4% 57.5% 65.4% State 80th Percentile 53.3% 57.4% 66.6% SUGGESTED INTERVENTIONS FOR HIGH OUTLIERS: This could indicate that the SNF is improperly billing for therapy services. The SNF should determine whether therapy provided was reasonable and medically necessary, and that the amount of therapy reported on the MDS is supported by documentation in the medical record.

8 Need to audit? When reviewing this information, you may want to consider auditing a sample of records if you identify: Therapy s 120% 100% Increasing Target Percents over time resulting in outlier status Your Target Percent (first row in the table below) is above the national 80th percentile Target Percent 80% 60% 40% 20% 0% 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 SNF Natl: 80th %ile Juris: 80th %ile State: 80th %ile YOUR SNF 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 Target Area Percent 72.9% 67.2% 67.4% Target Count (Numerator: count of days billed within episodes of care ending in the report period for therapy s (see Appendix 1 in Skilled Nursing Facility PEPPER User's Guide)) 7,489 5,930 6,904 Denominator Count (count of days billed within episodes of care ending in the report period for therapy and nontherapy s (see Appendices 1 and 2 in Skilled Nursing Facility PEPPER User's Guide)) 10,279 8,819 10,249 Target (Numerator) Average Length of Stay Denominator Average Length of Stay *Data not available when target count less than 11. COMPARATIVE DATA Note: State Percentiles are zero when there are fewer than 11 SNFs in the jurisdiction's state or when there are no SNFs with at least 11 target discharges. National 80th Percentile 97.5% 96.7% 96.7% Jurisdiction 80th Percentile 93.9% 93.4% 93.5% State 80th Percentile 94.2% 93.5% 93.4% SUGGESTED INTERVENTIONS FOR HIGH OUTLIERS: This could indicate that the SNF is improperly billing for therapy services. The SNF should determine whether therapy provided was reasonable and medically necessary, and that the amount of therapy reported on the MDS is supported by documentation in the medical record.

9 Need to audit? When reviewing this information, you may want to consider auditing a sample of records if you identify: 90+ Day Episodes of Care 30% 25% Increasing Target Percents over time resulting in outlier status Your Target Percent (first row in the table below) is above the national 80th percentile Target Percent 20% 15% 10% 5% 0% 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 SNF Natl: 80th %ile Juris: 80th %ile State: 80th %ile YOUR SNF 10/1/09-9/30/10 10/1/10-9/30/11 10/1/11 9/30/12 Target Area Percent 24.5% 19.2% 15.7% Target Count (Numerator: count of episodes of care ending in the report period with a length of stay of 90+ days) Denominator Count (count of all episodes of care ending in the report period) Target (Numerator) Average Length of Stay Denominator Average Length of Stay Target (Numerator) Average Payment $35,778 $44,266 $46,697 Target (Numerator) Sum of Payments $1,788,893 $1,637,825 $1,587,711 *Data not available when target count less than 11. COMPARATIVE DATA Note: State Percentiles are zero when there are fewer than 11 SNFs in the jurisdiction's state or when there are no SNFs with at least 11 target discharges. National 80th Percentile 26.8% 25.9% 25.4% Jurisdiction 80th Percentile 20.7% 19.6% 21.3% State 80th Percentile 22.5% 21.4% 21.9% SUGGESTED INTERVENTIONS FOR HIGH OUTLIERS:. This could indicate that the SNF is continuing treatment beyond the point where those services are necessary. The SNF should review documentation for beneficiary episodes of care with a length of stay of 90+ days to ensure that beneficiaries' continued care is appropriate and that they received a skilled level of care. The SNF should review plans of care for appropriateness and assess appropriateness of discharge plans.

10 SNF Top s , SSNF Name SNF Top s for All Episodes of Care* (EOC), Most Recent 4 Qtrs. In Descending Order by Number of Days Billed Total SNF EOC: 217 Code Number of Days Billed % of Days to Total Days % of EOC with the Billed to Total EOC Average Length of Stay By Description RUB Rehabilitation Ultra High with ADL , % 41.0% 37.1 RUC Rehabilitation Ultra High with ADL , % 23.0% 36.8 LE2 Special Care Low with Depression and ADL % 6.5% 44.4 ES3 Extensive Services Tracheostomy Care and Ventilator/respirator and ADL % 10.1% 28.3 RUA Rehabilitation Ultra High with ADL % 12.0% 21.8 HE2 Special Care High with Depression and ADL % 6.9% 26.1 RMC Rehabilitation Medium with ADL % 6.9% 16.7 HC2 Special Care High with Depression and ADL % 3.7% 29.6 RHC Rehabilitation High with ADL % 3.7% 26.3 RMB Rehabilitation Medium with ADL % 5.1% 16.7 HE1 Special Care High with No Depression and ADL % 7.4% 11.3 HD1 Special Care High with No Depression and ADL % 5.1% 14.5 LE1 Special Care Low with No Depression and ADL % 3.7% 19.0 LD1 Special Care Low with No Depression and ADL % 3.2% 19.1 ES2 Extensive Services Tracheostomy Care or Ventilator/respirator and ADL % 1.8% 33.5 HC1 Special Care High with No Depression and ADL % 5.1% 11.8 RUX Rehabilitation Ultra High And Extensive Services with ADL % 2.3% 25.4 RVB Rehabilitation Very High with ADL % 5.5% 10.3 CE1 Clinically Complex with No Depression and ADL % 2.3% 21.6 RUL Rehabilitation Ultra High And Extensive Services with ADL % 0.5% 74.0 Top s 9, % 28.3 All s 10, % 26.3 * An episode of care (EOC) is defined as a series of claims from a SNF for a beneficiary where the difference between the "Through Date" of one claim and the "From Date" of the subsequent claim is less than or equal to thirty days. The "From" and "Through" dates in form locator 6 (statement covers period) on the claim identify the span of service dates included in a particular bill; the "From" date is the earliest date of service on the claim. Note: s will display for which there are a total of at least 11 days billed to the respective during the most recent fiscal year. Worksheet: SNF Top s Page: 10

11 SNF Top s With 90+ Days SNF Name SNF Top s for All Episodes of Care* (EOC) with 90+ Days, Most Recent 4 Qtrs. In Descending Order by Number of Days Billed Total SNF EOC: 34 Code Number of Days Billed % of Days to Total Days % of EOC with the Billed to Total EOC Average Length of Stay By Description RUB Rehabilitation Ultra High with ADL % 44.1% 57.3 RUC Rehabilitation Ultra High with ADL % 38.2% 45.8 LE2 Special Care Low with Depression and ADL % 23.5% 56.3 HE2 Special Care High with Depression and ADL % 11.8% 41.0 HC2 Special Care High with Depression and ADL % 5.9% 66.5 ES2 Extensive Services Tracheostomy Care or Ventilator/respirator and ADL % 5.9% 59.5 RHC Rehabilitation High with ADL % 5.9% 56.0 ES3 Extensive Services Tracheostomy Care and Ventilator/respirator and ADL % 5.9% 55.0 LE1 Special Care Low with No Depression and ADL % 8.8% 29.3 RUA Rehabilitation Ultra High with ADL % 5.9% 39.0 RUL Rehabilitation Ultra High And Extensive Services with ADL % 2.9% 74.0 LB1 Special Care Low with No Depression and ADL % 2.9% 66.0 RVB Rehabilitation Very High with ADL % 11.8% 14.8 RMB Rehabilitation Medium with ADL % 5.9% 28.5 HE1 Special Care High with No Depression and ADL % 8.8% 17.0 LD1 Special Care Low with No Depression and ADL % 5.9% 25.0 RUX Rehabilitation Ultra High And Extensive Services with ADL % 5.9% 20.5 CC1 Clinically Complex with No Depression and ADL % 2.9% 37.0 LC1 Special Care Low with No Depression and ADL % 2.9% 30.0 RHB Rehabilitation High with ADL % 2.9% 30.0 Top s 3, % 45.1 All s 3, % 39.4 * An episode of care (EOC) is defined as a series of claims from a SNF for a beneficiary where the difference between the "Through Date" of one claim and the "From Date" of the subsequent claim is less than or equal to thirty days. The "From" and "Through" dates in form locator 6 (statement covers period) on the claim identify the span of service dates included in a particular bill; the "From" date is the earliest date of service on the claim. Note: s will display for which there are a total of at least 11 days billed to the respective during the most recent fiscal year.

12 SNFs For Demo Jurisdiction (DMSTR) Jurisdiction Top s for All Episodes of Care* (EOC), Most Recent 4 Qtrs. In Descending Order by Number of Days Billed Total SNF EOC: 149,396 Code Number of Days Billed % of Days to Total Days % of EOC with the Billed to Total EOC Average Length of Stay By Description RUB Rehabilitation Ultra High with ADL ,032, % 29.5% 23.4 RUC Rehabilitation Ultra High with ADL , % 17.1% 26.2 RVB Rehabilitation Very High with ADL , % 17.6% 18.2 RVC Rehabilitation Very High with ADL , % 13.2% 20.3 RUA Rehabilitation Ultra High with ADL , % 13.3% 17.1 RHC Rehabilitation High with ADL , % 9.3% 19.9 RVA Rehabilitation Very High with ADL , % 10.9% 15.7 RHB Rehabilitation High with ADL , % 9.1% 17.4 RMC Rehabilitation Medium with ADL , % 7.5% 16.6 RMB Rehabilitation Medium with ADL , % 6.5% 14.3 RHA Rehabilitation High with ADL , % 5.6% 15.5 RMA Rehabilitation Medium with ADL , % 4.4% 14.1 LE1 Special Care Low with No Depression and ADL , % 1.7% 26.8 HE1 Special Care High with No Depression and ADL , % 2.0% 15.7 LD1 Special Care Low with No Depression and ADL , % 1.7% 18.6 ES3 Extensive Services Tracheostomy Care and Ventilator/respirator and ADL , % 0.8% 39.7 LC1 Special Care Low with No Depression and ADL , % 1.3% 16.3 HD1 Special Care High with No Depression and ADL , % 1.8% 12.2 HB1 Special Care High with No Depression and ADL , % 1.4% 13.0 LE2 Special Care Low with Depression and ADL , % 0.7% 25.1 Top s Jurisdiction-wide 4,565, % 19.7 All s Jurisdiction-wide 4,954, % 18.8 * An episode of care (EOC) is defnined as a series of claims from a SNF for a beneficiary where the difference between the "Through Date" of one claim and the "From Date" of the subsequent claim is less than or equal to thirty days. The "From" and "Through" dates in form locator 6 (statement covers period) on the claim identify the span of service dates included in a particular bill; the "From" date is the earliest date of service on the claim. Note: s will display for which there are a total of at least 11 days billed to the respective during the most recent fiscal year. Worksheet: Jurisd. Top s Page: 12

13 SNFs For Demo Jurisdiction (DMSTR) Jurisdiction Top s for All Episodes of Care* (EOC) w/ 90+ Days, Most Recent 4 Qtrs. In Descending Order by Number of Days Billed Total SNF EOC: 10,676 Code Number of Days Billed % of Days to Total Days % of EOC with the Billed to Total EOC Average Length of Stay By Description RUC Rehabilitation Ultra High with ADL , % 31.7% 45.8 RUB Rehabilitation Ultra High with ADL , % 32.0% 42.8 RVC Rehabilitation Very High with ADL , % 25.9% 30.4 RVB Rehabilitation Very High with ADL , % 24.9% 29.3 RHC Rehabilitation High with ADL , % 21.3% 30.4 RMC Rehabilitation Medium with ADL , % 18.2% 25.9 RHB Rehabilitation High with ADL , % 17.3% 26.5 LE1 Special Care Low with No Depression and ADL , % 8.6% 46.7 RUA Rehabilitation Ultra High with ADL , % 11.0% 32.8 RMB Rehabilitation Medium with ADL , % 13.1% 23.0 RVA Rehabilitation Very High with ADL , % 10.9% 26.7 LD1 Special Care Low with No Depression and ADL , % 7.3% 31.3 ES3 Extensive Services Tracheostomy Care and Ventilator/respirator and ADL , % 2.6% 79.3 RHA Rehabilitation High with ADL , % 7.7% 26.3 HE1 Special Care High with No Depression and ADL , % 5.5% 32.7 RMA Rehabilitation Medium with ADL , % 6.4% 25.3 LC1 Special Care Low with No Depression and ADL , % 5.4% 28.1 LE2 Special Care Low with Depression and ADL , % 3.4% 41.4 HD1 Special Care High with No Depression and ADL , % 4.2% 25.5 HC1 Special Care High with No Depression and ADL , % 3.5% 23.8 Top s Jurisdiction-wide 931, % 33.5 All s Jurisdiction-wide 1,053, % 32.1 * An episode of care (EOC) is defined as a series of claims from a SNF for a beneficiary where the difference between the "Through Date" of one claim and the "From Date" of the subsequent claim is less than or equal to thirty days. The "From" and "Through" dates in form locator 6 (statement covers period) on the claim identify the span of service dates included in a particular bill; the "From" date is the earliest date of service on the claim. Note: s will display for which there are a total of at least 11 days billed to the respective during the most recent fiscal year.