‘Most Harmful’: Health Insurer Prior Authorization Reforms Fall Short of Nursing Home Industry Expectations

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 –  […]

[UPDATED] CMS Revamps Care Compare to Drop Third-Cycle Nursing Home Inspections, Add Greater Transparency for Chains

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 […]

‘Punitive and Vindictive’ Regulation: Inside Ignite’s Juggling of Burdens from Medicare Advantage to Surveys

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 […]

MedPAC Urges Reform of Medicare Advantage, Noting ‘Design Flaws’ in Nursing Home Payment Models

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 […]

As OIG Urges More Oversight of Nursing Home Staffing, CMS Pushes Back Citing ‘Limited Resources’

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 […]

Inside Claim Denials for Nursing Homes, and Best Tips to Maximize Success Through MDS Coding

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, […]

Staffing, Scrutiny and Surge: How Nursing Homes Are Adapting and Rethinking Models of Care in 2025

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 […]

Compliance Radar: Amazon Deliveries, Role Overload and Other Top Skilled Nursing Citation Risks

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, […]

The ‘Learning Curve’: Antipsychotics, QAPI Among Changes Needing Clarity on New Nursing Home Survey

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, […]

CMS Moving ‘Full Steam’ On Value-Based Care, But Nursing Homes Could Be Impacted By Payment Neutrality Push

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 […]

New CEO at Focused Post Acute Care Digs into Disproportionate Fines, Record IJ Citations

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 […]

More Than 25% of Nursing Homes Slash Food Spending Below $10 a Day

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 […]

Inside Efforts at Nursing Homes to Stabilize the MDS Workforce Amid Rising Demand

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 […]

‘Airtight Documentation’ Matters: Inside Upcoming Nursing Home Survey Changes Taking Effect April 28 

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 […]

‘Vast Majority’ of Nursing Homes Still Scrambling to Complete Off-Cycle Revalidation Paperwork, CMS Pushes Deadline

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 […]