More than 40 health insurance providers announced a joint initiative on Monday and met with Trump administration officials to overhaul and streamline the prior authorization process by reducing administrative burdens on health care providers. However, there remains a big question mark over whether the move will ease pain points for nursing homes. The insurers – […]
In the latest litigation over the federal staffing mandate, Judge Leonard T. Strand for the Northern District of Iowa vacated crucial aspects of the rule earlier this week, namely that a registered nurse (RN) needs to be on-site 24 hours a day, seven days a week. The ruling also vacates implementing minimums of total nurse […]
The Centers for Medicare and Medicaid Services (CMS) is making several updates to the Nursing Home Care Compare tool to improve accuracy and transparency, it stated in a memo Wednesday. The federal agency will begin posting “aggregated” performance data for nursing home chains in a clear, consumer-friendly format. Since 2022, CMS has released ownership data linking […]
Ignite Medical Resorts is entering the second half of 2025 eager for regulatory reform, but it has been able to overcome burdens stemming from managed care so far by envisioning it as a “core competency” alongside a strong focus on tech innovation. The company is also forging ahead with plans to grow its physical footprint […]
While Centers for Medicare & Medicaid Services (CMS) has made improvements following previous recommendations from the Medicare Advisory Commission (MedPAC), the Medicare Advantage (MA) program and the value-based purchasing program still suffer from “design flaws,” according to the organization. MedPAC is calling attention to what it perceives as design flaws in the programs, including incentives […]
A report released Monday by the Office of the Inspector General (OIG) is recommending that the Centers for Medicare and Medicaid Services (CMS) strengthen its oversight of nursing home staffing by enhancing how it uses Payroll-Based Journal (PBJ) data. The OIG is urging the federal agency to flag all nursing homes that provide fewer than […]
Aligning diagnosis codes on the Minimum Data Set (MDS) with claim forms used to bill Medicare and Medicaid can’t be understated, especially considering annual revenue losses of $25,000 to $30,000 per nursing home as a result of incorrect coding. Billing software and careful use of the ICD-10 manual, along with close collaboration across care teams, […]
The Office of Inspector General (OIG) is requesting $454.4 million in its fiscal year 2026 budget to continue fighting fraud, waste, and abuse in the U.S. Department of Health and Human Services (HHS) programs, with nursing homes being identified as one of its three main areas of priority, with the reduction of antipsychotic drug use […]
The nursing home sector is undergoing a significant transformation in real time, driven by a recognition that the traditional, reactive model is no longer sustainable. Changes in occupancy patterns, increasing patient acuity, evolving workforce dynamics, and shifting payment structures are all contributing to this redefinition, according to Austin Steele, chief strategy officer for Indiana-based operator […]
The Centers for Medicare & Medicaid Services (CMS) on Friday released a draft version of the Minimum Data Set (MDS) with four Section R items removed. In the prospective payment system (PPS) proposed rule for skilled nursing facilities (SNFs), released last month, CMS floated the removal of these MDS items, which assess elements related to […]
Easily preventable and overlooked compliance issues in nursing homes often start in the kitchen and resident rooms, but there is another surprising source: Amazon deliveries. All the while, the category of infection prevention and control continues to lead in number of citations. and surveyors often see multiple failure points when it comes to person-centered care, too, […]
There’s still ambiguity in how surveyors will interpret new elements of survey changes, but tightening up documentation to best reflect a resident’s condition and care plan goals will be key for nursing homes adjusting to these. According to operators who’ve begun implementing these changes, the new survey effective April 28 aims to improve assessment accuracy, […]
The new direction of the Centers for Medicare and Medicaid Services (CMS) renews focus on harmonizing payments across care settings – a shift that could impact nursing home profits – even as the federal agency’s commitment to advancing value-based care (VBC) remains strong. In a meeting held by the Center for Medicare and Medicaid Innovation […]
A nursing home regulatory model focused on real-time collaboration between state, federal and provider leaders is crucial, considering existing outdated and punitive regulatory practices seen in some states. In Texas, for example, there’s a disproportionate issuance of immediate jeopardy (IJ) citations and associated financial penalties, which discourage investment in the industry while demoralizing staff, Focused […]
High-level citations could be on the rise since new requirements for transfers and discharges went into effect on April 28. Immediate jeopardy (IJ) citations, for instance, that are dreaded by nursing home operators and are often the result of the many benign and avoidable ways facility staff can misunderstand the citation, can increase with the […]
Cost-cutting measures in nursing homes, particularly food budgets, have been a concerning underlying issue in the industry, with more than a quarter of facilities in the country spending under $10 per day on food per resident. An investigative report by NJ Advance Media, in collaboration with Rutgers University and data experts at SNFdata Resources of […]
While the demand for nursing home MDS coordinators has always been higher than their availability, some organizations are beginning to see fruits from concerted efforts to stabilize this specialized role. MDS coordinators ensure accuracy of minimum data set (MDS), which in turn is evaluated by surveyors. With brand new survey changes going into effect Monday […]
The Department of Veterans Affairs (VA) has yet to address a recommendation made by the U.S. Government Accountability Office (GAO) to identify additional enforcement actions for VA nursing homes, and to ensure such facilities comply with quality standards. The recommendation was made as part of a November 2022 report to help the VA oversee these […]
Changes to nursing home survey protocols — set to take effect April 28 — are putting a sharper focus on resident rights, documentation practices, and medication oversight. The revisions demand airtight documentation, particularly around discharge, behavioral health interventions and psychotropic drug use. Of the ten area changes due to take place, providers should pay the […]
The Centers for Medicare and Medicaid Services (CMS) is once again delaying the deadline to file revalidation paperwork, moving it from May 1 to August 1. It’s a welcome relief for operators given that a vast majority of nursing homes haven’t completed the burdensome paperwork. Martin Allen, senior vice president of reimbursement policy at the […]
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