Length of Nursing Home Medicare/Medicaid Payment Denials Per State

Nursing home penalties can be classified in two different ways. One is monetary fines and the second is a denial of Medicare and Medicaid payments. For the second penalty type to be imposed on a nursing home the facility must already be non-complaint on the issue for a total of three months. Initially, it applies only to new individuals admitted with Medicare/Medicaid payments but eventually evolves to include all individuals for which the nursing home is receiving Medicare/Medicaid payments. The payment denial spans the amount of time that each home continues with its non-compliance. If the issue is not resolved within an additional three months, the nursing home is terminated from participating in the Medicare/Medicaid program.

The average length of denial for all 50 states is 25 days. In comparison, the average lengths for New Jersey and Idaho are surprisingly long, with numbers reaching more than double the average. What makes this all the more interesting is that Idaho placed 6th highest and New Jersey placed 11th highest within the recorded states in terms of the overall average nursing home ratings. Another positive ranking that both these states have is their overall count of payment denial violations. Idaho nursing homes have a total of 9 payment denials, putting them in the bottom 3rd of all states. New Jersey has even less, with 3, putting at the very bottom with only 3 states having fewer overall payment denials.

That brings us to the reasoning behind Idaho and New Jersey having visible larger average payment denial lengths. With a smaller sample size of overall payment denials, a single value has more weight in determining the average for the entire state. In theory, having a very low amount of payment denial sizes is a very good thing. However, for these two states it ended up being the reason that the calculation for their average was so large compared to the overall average.

Information determines the point of view of the narrative and with only the data from the above graph it’s easy to assume that Idaho and New Jersey nursing homes are inadequate, which is clearly not the case judging from the additional information presented. Even small mistakes can cause statistically significant skews in data.

Companies like Clearpol, Inc. are there to assist in making sure violations don’t happen to begin with. Our goal is to add intelligence into policy management, so that nursing homes can keep up to date and avoid becoming an extreme outlier in the data pool.

By Viktoriya Nikiforova