When conferences were a staple of business development and not potential sources of contagion from COVID-19, skilled nursing providers would frequently pack the rooms featuring sessions on institutional special needs plans (I-SNPs). Under this model, SNFs can move into the Medicare Advantage world by offering their own insurance plans to beneficiaries who are living in […]
Category: Medicare Advantage
Some aspects of the nursing home world do not change even during a global pandemic, and that includes the need to manage relationships with multiple payers. Several managed care organizations (MCOs) are now sending in their new contracts to skilled nursing providers as old agreements expire, Chad Bogar, the founder and CEO of the law […]
Providers of nursing home care and other long-term services continued to expand their Medicare Advantage offerings into the 2021 plan year, as more operators look to gain financial control in a landscape where managed care maintains its steady march toward a Medicare majority. The number of provider-led Institutional Special Needs Plans (I-SNPs) increased from 76 […]
In the years just prior to the arrival of a global pandemic that uniquely affects skilled nursing facilities, many providers were interested in expanding their role in the provision of care by moving into the insurance field. And even though the toll of COVID-19 has sent costs spiraling for those operators who made the leap […]
Medicare Advantage (MA) has seen dramatic enrollment growth over the past six years, significantly outpacing traditional Medicare, according to a report commissioned by the Better Medicare Alliance released October 15. The report, prepared by the actuarial firm Milliman, examined the growth in enrollment in MA and the similarities and differences between enrollees in that program […]
Even with limited data due to COVID-19, an annual benchmarking report found that the operating margin for skilled nursing facilities remained at zero for 2019. And given the costs of managing operations during the pandemic — to say nothing of the occupancy hit — the picture is bleak for margins in 2020. But for all […]
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, […]
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 […]
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