The growing prevalence of Medicare Advantage (MA) plans in many skilled nursing markets has been a source of mounting challenges for operators, many of whom are wondering whether they can keep up with the change. Yet a few strategies can go a long way to make the transition work, experts said. They cite leveraging data […]
Category: Medicare Advantage
More government scrutiny of Medicare Advantage (MA) plans and data sharing with nursing homes could reduce claims denials and burdens associated with such plans, sector leaders have long argued. And now a report released Thursday by a Congressional advisory body backs that view in shedding light on how enrollees are captured in data. The Medicare […]
Soaring costs associated with skilled nursing – and problematic payer sources – are making it harder for continuing care retirement communities (CCRCs) to provide such labor intensive post-acute care. CCRCs have to ask themselves some hard questions when it comes to what services they can reasonably offer, and if it’s worth it to keep open […]
Sanford Health announced plans Tuesday to break ground on a $200 million project for a continuing care retirement community (CCRC) in South Dakota through its subsidiary, the Evangelical Lutheran Good Samaritan Society. The Good Samaritan Society executives told Skilled Nursing News that the funding for the project is an outcome of a strategy to expand […]
The Centers for Medicare & Medicaid Services (CMS) is placing limits on the use of artificial intelligence (AI) tools in denials of claims related to Medicare Advantage plans, and adding more guidance to health care providers on post-acute care admissions. The agency issued an FAQ Tuesday to address concerns related to coverage criteria and utilization […]
Piece by piece, nursing home operators are seeing stricter government oversight of Medicare Advantage (MA) plans, a welcome relief given that partnerships with such managed care plans have become a huge source of administrative burden for providers in the sector, especially as workforce shortages persist. Most recently, the Centers for Medicare & Medicaid Services (CMS) […]
Nursing home operators can expect to see a lot more regulatory activity in the next few months, with rules and regulations being finalized prior to a potential presidential administration change, with that administration taking office in 2025. A slew of proposed and finalized rules were issued by the Centers for Medicare and Medicaid Services (CMS) […]
As Medicare Advantage becomes an increasingly important – and controversial – payer for skilled nursing services, operators should note a major shift has occurred in the insurance landscape. Cigna Group (NYSE: CI) agreed Wednesday to sell its Medicare businesses and CareAllies to Health Care Service Corporation (HCSC). HCSC said it intends to acquire the Cigna […]
The federal government’s Medicare Advantage and Part D proposed rule offers nursing home operators several favorable updates, including those related to the appeals process for terminating SNF services as well as alleviating burdens posed by choice and multiple plans for dual eligible residents. The Centers for Medicare & Medicaid Services (CMS) has been working on […]
The majority of MedPAC board members voted Thursday to recommend reducing Medicare-based payment rates for skilled nursing spending by 3% for 2025, despite voicing concerns about the federal minimum staffing proposed rule. MedPAC, which stands for the Medicare Payment Advisory Commission, is made up of health care professionals who make recommendations to Congress in terms […]
The Covid-19 pandemic’s labor crisis forced some nursing home providers to adapt their business practices in 2023, during a time some leaders termed the “year of recovery.” And, as they look ahead to 2024 amid a looming federal staffing mandate, many nursing home providers look to gain from these efficiencies – but are fearful about […]
Margins squeezed by interest rates and inflation, staffing shortages amid a draconian staffing mandate proposal, an invasion of Medicare Advantage and mixed efforts at adapting to Minimum Data Set (MDS) changes are among a litany of the challenges facing the skilled nursing sector at the start of 2024. However, all is not doom and gloom […]
As the Covid-19 public health emergency officially ended in 2023, the nursing home sector continued to face lingering troubles across many facets of the business even if spread of disease – and death resulting from it – diminished as a concern. Chief among troubles that continued to plague nursing homes included workforce shortages and expansion […]
Operating a skilled nursing facility today is considered a difficult business with regulations and reimbursement woes making the space “tougher every day.” As a result, some operators say they regularly budget a loss for skilled nursing services, and if it weren’t for other lines of business, skilled nursing would be unsustainable. This dire view of […]
Nursing homes and continuing care retirement communities (CCRCs) made up $191.3 billion of national health expenditures in 2022, an increase from $181.1 billion in 2021, reaching levels close to the onset of the Covid-19 pandemic. Pre-pandemic, such expenditures sat between $162 billion and $174.1 billion between 2016 and 2019, according to a survey published by […]
In facing a class-action lawsuit for its use of artificial intelligence in denying claims for services to residents in post-acute care, Humana (NYSE: HUM) joins the ranks of other health insurance behemoths such United Healthcare and Cigna. The complaint, filed late Tuesday, in a federal court in Kentucky, accuses Humana of using AI tools – […]
Minimum Data Set (MDS) changes for 2024, along with updates to nursing home surveys were top of mind among representatives of the Centers for Medicare & Medicaid Services on Thursday, as the agency outlined its plans for next year in an Open Door Forum. CMS plans to release the MDS 1.19.1 in early 2024 with […]
In order to keep Medicare Advantage plans in check for denial of services, provider organizations are pressuring federal authorities to do more, and asking them to closely monitor and aggressively enforce reforms for these plans as envisioned in a final rule that takes effect on Jan. 1. Companies managing MA plans have said they don’t […]
The costs of long-term care in every setting, including nursing homes, is considered out of reach for most seniors, averaging more than $100 per day nationwide. This is coupled with the fact that the majority of older adults with very low incomes will need such services and have the fewest resources to pay for them. […]
Operational pressures continue to shape the landscape of the skilled nursing sector as many organizations with assets across the care continuum are divesting nursing homes in favor of other service lines. Responding to pressures from staffing and low reimbursements, Ohio Living decided to act “proactively” and downsize its skilling nursing segment while growing its services […]