While the skilled nursing landscape continues to struggle both operationally and financially during the COVID-19 pandemic, those same negative forces have only served to strengthen private health plans — putting Medicare Advantage in an even better position to continue its growth. Cratering census and sharp declines in elective surgeries, while fiscally devastating for nursing homes, […]
Category: Medicare Advantage
A leading wound care provider sees expansion opportunity in both skilled nursing and the home despite the ongoing strains of COVID-19, with a recent private equity investment to back it up. American Medical Technologies in late August announced its acquisition by private equity firm One Equity Partners and investment management company The Silverfern Group, capping […]
The rising tide of managed care enrollment for both Medicare and Medicaid patients continues to swell, and as the nation grapples with the costs of the pandemic, SNFs should be aware of the moves states might make to implement some type of managed care model as they try to secure budgetary stability. The steady increase […]
Amedisys Inc. (Nasdaq: AMED) has already logged an uptick in diversions from skilled nursing facilities as the COVID-19 pandemic rages on, and leaders at the home health giant see even more opportunity ahead with a more expansive SNF-at-home model. “We have not seen a material recovery in elective procedures, yet we have seen a significant […]
The Centers for Medicare & Medicaid Services (CMS) on Friday instructed Medicare Advantage plans and Medicare Administrative Contractors (MACs) to begin covering all COVID-19 tests required for nursing home residents under new testing guidelines. The move came after the Centers for Disease Control & Prevention (CDC) updated its guidance around nursing home testing strategies last […]
In the era before COVID-19, specialty in-house Medicare Advantage plans had emerged as one of the hottest topics in long-term care — control the payer source, the thinking went, and an operator could eliminate the financial uncertainty and pressure that comes when working with managed care plans. But with a global pandemic running rampant through […]
As skilled nursing facilities across the country locked down to try to curb the spread of COVID-19, try to stay on top of constantly changing guidance from both the state and federal level, and navigate new mandates to report COVID-19 cases, it might be easy for them to overlook reaching out to insurers working as […]
The federal government has granted Medicare Advantage plans significant leeway when it comes to setting payment rates and other rules for skilled nursing facilities. In normal times, the crazy quilt of managed-care policies and exceptions creates headaches for operators and their billing teams. Amid the ongoing COVID-19 crisis, widespread variations in Medicare Advantage behavior add […]
Multiple managed care plans have made changes to their procedures for admissions to the skilled nursing setting amid the ongoing coronavirus pandemic, with several major companies suspending prior authorization requirements for admissions to a skilled nursing facility. The changes, however, are not uniform — and that’s if the managed care organization (MCO) chooses to make […]
Over the past few weeks, we’ve seen the federal government rapidly dismantle the dense scaffolding of rules and regulations that had been built over the course decades, all in the name of fighting the novel coronavirus. Ideas once unthinkable — doctors providing consultations over Skype without fear of violating HIPAA, a blanket freeze on the […]
Medicare Advantage plans have long been a thorn in skilled nursing facilities’ sides, with lower-per day rates and increased pressure to reduce lengths of stay than traditional fee-for-service Medicare. But a new report shines a light on why seniors are increasingly choosing the plans in the first place, reinforcing recent calls to embrace working with […]
The new fee-for-service payment model for nursing homes took up most of the oxygen in the industry over the past two years, but the rise of Medicare Advantage in markets across the country could make all of that preparation for naught — sooner than many may think. The Patient-Driven Payment Model (PDPM) for nursing homes […]
As the skilled nursing industry struggles to adapt to a new Medicare payment landscape, in-house Medicare Advantage plans have emerged as one of the hottest topics among leaders — while the space’s publicly traded behemoth has thrown its full support behind the separate accountable care organization (ACO) model. There may not be one set answer […]
With all the changes that have swept the skilled nursing industry over the last decade, one of the classic investment models in the space may need to evolve with the times. “I think that the REIT model is dead,” Robert Hartman, founder of Symphony Post Acute Network, said during a Monday panel discussion at the […]
Fresh off a successful Series A funding round, a telehealth company that built its platform around serving rural skilled nursing facilities sees growth ahead in urban markets — as well in serving other post-acute providers along the continuum. TapestryCare last week announced the completion of a funding round led by the New York City-based Sopris […]
The new fee-for-service Medicare model absorbed much of the oxygen around nursing home payment reform in 2019, but 2020 — as well as the years beyond — will bring a slew of alternate payment pressure to the post-acute sector. Over the next two years alone, 95% of post-acute operators will find themselves in new payment […]
Early analyses of the new Medicare payment model for nursing homes indicate that operators may be pulling in more money than the federal government intended — leading to widespread speculation that adjustments could be coming sometime in 2020. American Health Care Association (AHCA) president and CEO Mark Parkinson agrees with the idea that the Patient-Driven […]
The federal government on Monday announced the appointment of Brad Smith, a health care and insurance industry veteran, as the next head of the Center for Medicare & Medicaid Innovation (CMMI). Smith, previously the chief operating officer at insurance giant Anthem’s diversified business group, will additionally serve as senior advisor for value-based transformation to Department […]
As skilled nursing facilities work to establish their position in an increasingly value-based health landscape, many are looking at the world of Medicare Advantage as more than a pressure point for billing. They see it as an opportunity to take control of the premium dollar, moving into the business of providing insurance for their patients. […]
Skilled nursing operators, increasingly fed up with demands for lower lengths of stay from their managed insurance partners — with little to no savings to show for it — have moved to seize control of the premium dollar by becoming insurance entities themselves. The primary way they can do this, launching a certain subset of […]
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