GRS Regulatory Update: 
Skilled Nursing facility utilization and payment public use file (SNF PUF) – released by CMS


Issued October 5, 2017

SUMMARY
On October 03, 2017, Centers for Medicare and Medicaid Services (CMS) released updated data for the Skilled Nursing Facility Utilization and Payment Public Use File (Skilled Nursing Facility PUF). The information included in this report is based on 2015 SNF Medicare claims paid under the Medicare fee-for-service program.  This is the third year this report has been generated by CMS.

OVERVIEW OF DATA SET
As per the Medicare Skilled Nursing Facility PUF Methodology document (pages 9 and 10):

  • “Although the Skilled Nursing Facility PUF has a wealth of payment and utilization information about SNF utilization and payment, the dataset also has a number of limitations that are worth noting”. 
  • “The information presented in this file also does not indicate the quality of care provided by individual SNFs. The file only contains cost and utilization information”. 
  • “Additionally, the data are not risk adjusted and thus do not account for differences in the underlying severity of disease of patient populations treated by providers”.

 
The data in the Skilled Nursing Facility PUF covers calendar year 2015 and contains 100% final-action (i.e. all claim adjustments have been resolved) skilled nursing facility institutional claims for Medicare fee-for-service beneficiaries. This updated data allows providers to conduct numerous analyses of RUGs data for cost and utilization.  The following table summarizes the five data files available through the 2015 report:


Provider Aggregate
organized by SNF 
  • Total stays and average length of stay; 
  • Total utilization and payment for the year, including: provider charge amount, allowed amount, Medicare payment, standard payment. 
  • Beneficiary demographic and chronic condition information. 
Provider by RUG Aggregate organized by SNF and RUG
  • Average utilization and payment per day/beneficiary, including: provider charge amount, allowed amount, Medicare payment, standard payment.
RUG Aggregate
organized by RUG
  • Information on utilization, Medicare payment and submitted charges
RUG by State Aggregate 
organized by RUG by state 
  • Information on utilization, Medicare payment and submitted charges 
Therapy Minutes Aggregate
listed by provider  
  • Number of RV/RU assessments submitted by a SNF; 
  • Percent of RV/RU assessments where the number of therapy minutes falls within 10 minutes of the minimum therapy minute threshold necessary to qualify for that RUG category. 

RESOURCES
Additional information can be found at the Frequently Asked Questions page. 

The Regulatory Administration department of GRS/RHS closely monitors legislative and regulatory notices, and continues to work with Congress, CMS and industry leaders regarding changes in government regulations that may impact patient care and service delivery.