The Centers for Medicare & Medicaid Services (CMS) is taking new steps to improve Medicare Advantage (MA) access and transparency, including reforms to prior authorizations and the use of AI tools to deny coverage, as outlined in the 2026 Medicare Advantage and Part D proposed rule, officials said during a call on Tuesday. The Contract […]
President-elect Donald Trump has picked Dr. Mehmet Oz, the renowned celebrity physician, to serve as administrator of the Centers for Medicare & Medicaid Services (CMS). The appointment was announced on Tuesday afternoon. “Our broken Healthcare System harms everyday Americans, and crushes our Country’s budget. Dr. Oz will be a leader in incentivizing Disease Prevention, so […]
Of the many significant factors affecting the skilled nursing industry in the last five years, Medicare Advantage was named as a major disruptor, as cost reports show a shift in operating margins with more facilities struggling financially. Stephen Taylor, principal of senior living and care segment leader for CliftonLarsonAllen (CLA), said MA has had “one […]
Optum is scaling back its Medicare Advantage Special Needs Plans for nursing home and assisted living residents in several regions. The health care services arm of insurance giant UnitedHealth Group (NYSE: UHG), Optum, made headlines earlier this year for workforce cuts. Now, the company is shutting down Institutional Special Needs Plans (I-SNPs) in several states, […]
While prior authorization has a legitimate role in Medicare Advantage coverage, the practice has expanded to the point of negatively affecting care. This aspect of MA needs to be right sized, and likely through legislation, nursing home leaders said. About 90%-plus of physicians, including those serving nursing home patients, have said that one or more […]
Medicare Advantage’s prior authorization process has resulted in higher denial rates among three of the largest health insurance providers, whose use of predictive AI tools raises serious concerns about patient care, according to a new report issued by a Senate subcommittee on Thursday. “[F]or beneficiaries of Medicare Advantage [prior authorization] has become not just a […]
Staffing shortages and increased acuity of patients are playing a big role in referral placement, along with preferences and prerequisites of referral sources. This is causing nursing homes and hospitals in high-demand areas to get creative with in-house offerings and hospital partnerships, as they are still experiencing bottlenecks in the referral process. At the same […]
Nursing homes and hospitals are developing closer ties and improving communication, and with this trend, admissions into nursing homes are expected to increase as rehospitalizations and excessive lengths of stay are also seen as declining. With rising acuity and staffing shortages of recent years, nursing homes have often been reluctant in admitting challenging cases that […]
Longevity Health and Infinity Healthcare Consulting on Wednesday announced a joint venture for institutional special needs plans (I-SNPs), marking Longevity’s entry into three new states, along with the expansion of its existing business into an additional state. Longevity and Infinity’s clients will collaborate to assist I-SNP members living in Infinity nursing facilities across Indiana, Kentucky […]
In weathering the rise of managed care penetration – which has often meant lost profits – nursing homes are turning to centralized processes for handling claims, beefing up teams to handle additional documentation requests (ADRs), and closely tracking contract renewals. Rates for managed care plans like Medicare Advantage are often lower than traditional fee-for-service Medicare […]
Coming off of his first year as CEO of American Senior Communities Steve Van Camp is busy planning an Institutional Special Needs Plan (I-SNP) joint venture with five other providers in Indiana, while also devoting time and resources to meeting quality measures and outcomes among ASC facilities. Important considerations to forge ahead with these efforts […]
Customer service, staff wellbeing, and tackling low reimbursement rates are some of the top priorities for nursing home operators as they prepare for the future. And educating and supporting care teams is especially important in order to strategize with the quality measures that will be implemented in the coming years, as these will have an […]
Negotiating power with Medicare Advantage (MA) plans may become easier as nursing homes explore participation in bundled payment options such as the Transforming Episode Accountability Model (TEAM), which enables following patients through an entire episode of care. It’s a lever available to participants and collaborators to forge new contracting strategies with their MA plan and […]
The national Medicare Advantage beneficiary admissions to nursing homes increased by 21.2% in 2021, and Medicare fee-for-service (FFS) admissions in the sector decreased by 13.8% between 2022 and 2023. Trella Health captured this data in its post-acute care industry trend report for 2024, confirming what the industry has been saying about the rise of MA […]
There’s been a flurry of regulatory activity related to Medicare Advantage (MA) in the first half of this year, with many policy actions being the result of extensive advocacy efforts among nursing home organizations. However, many of the regulations – such as those related to prior authorizations for certain services – as they stand are […]
Amid plans to launch the largest provider-owned institutional special needs plan (I-SNP) in the U.S., Brickyard Healthcare is also making sure it surpasses certain other challenges facing the sector. Along with this endeavor, eliminating agency use, preparing for managed Medicaid in Indiana, and being ready to face the staffing mandate, have all been top of […]
Over 50 lawmakers from both chambers of Congress are urging the Centers for Medicare and Medicaid Services (CMS) to increase scrutiny and regulation of artificial intelligence tools used by Medicare Advantage plans. In a letter addressed to CMS Administrator Chiquita Brooks-LaSure, the legislators expressed deep concerns over the use of AI algorithms by MA plans […]
Medicare Fee-for-Service, or traditional Medicare, admissions to nursing homes decreased significantly year over year by almost 20% in the fourth quarter of 2023. Coupled with this drop is a steady rise in Medicare Advantage enrollment, with such plans representing 54.7% of all beneficiaries enrolled in both Medicare Part A and B as of February, Trella […]
Operators have been opting for different payer sources other than Medicare Advantage plans given its persistent challenges. Medicare Advantage’s lower reimbursement rates compared to traditional Medicare and higher administrative burdens tied to prior authorizations and payment denials, have caused operators to seek even Medicaid as an alternative payer, emboldening efforts by advocacy groups to push […]
Expenditures for Nursing facilities and continuing care retirement communities (CCRCs) is expected to reach $237.6 billion in 2026, and $337.4 billion by 2032, according to data released Wednesday. Nursing homes and CCRCs have been increasing steadily since 2021, states a report prepared by the Office of the Actuary (OACT) at the Centers for Medicare & […]
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