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 […]
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 […]
Allegations against UnitedHealth Group (NYSE: UNH) that it secretly paid nursing homes in order to reduce hospital transfers of residents under its Medicare Advantage (MA) plans are leading lawmakers on both sides of the aisle to increase calls for a federal investigation. Last week, UnitedHealth filed a defamation lawsuit against the Guardian newspaper – whose […]
Physiatry is becoming a cornerstone of skilled nursing care in the midst of a push toward value-based reimbursement in Medicare and Medicaid. Its integration into care teams has helped improve outcomes while reducing costly hospitalizations, industry leaders said. The rise of patient acuity has been a huge driver in the evolution of physiatry in nursing […]
Nursing home stakeholders remain cautiously optimistic regarding Medicare Advantage plan audits announced by the Centers for Medicare and Medicaid Services (CMS) last month, but many hope the agency will extend the same scrutiny to prior authorizations, AI usage and internal coverage criteria. Operators are unlikely to face reimbursement cuts as a result of the audits, […]
While Medicare Advantage claim denials represent 17% of initial claim submissions, including those submitted by nursing home providers, about 57% of these denials are ultimately overturned. However, MA claim denials result in a 7% net reduction in provider MA revenue, due to the dollar-weighted share of claim denials that were not overturned, according to a […]
Payment from Medicare Advantage (MA) plans has long been a thorn in the side for nursing homes, but some organizations are beginning to see improvements – although rates still fall far short of covering the cost of quality care. “There’s not a big margin to be able to deliver care at 60% of what Medicare […]
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 […]
Legislation to streamline and improve outdated prior authorization processes for Medicare Advantage (MA) was reintroduced this week. The Improving Seniors’ Timely Access to Care Act would require MA plans to adopt an electronic prior auth system with standardized transactions, and improve transparency around MA prior auth use and requirements. It’s the third time this legislation […]
The UnitedHealth Group (Nasdaq: UNH) allegedly paid bonuses to nursing homes in order to reduce hospital transfers of residents under its Medicare Advantage (MA) plans, according to an investigation conducted by The Guardian. The investigation revealed these cost-cutting practices saved the company millions, but endangered patient health; this included delayed or denied emergency hospital care. […]
The current nursing home market has its share of positives and negatives midway through 2025, with operators enjoying Medicare and Medicaid reimbursement increases as well as a decline in facility supply, creating higher competition among buyers. Buyers are being more aggressive in the acquisition process, he said, with fewer facilities available. Brokerage firms are seeing […]
During a Congressional hearing held Wednesday, U.S. Department of Health & Human Services (HHS) Secretary Robert F. Kennedy Jr. defended the Trump administration’s proposed cuts to top health agencies as lawmakers questioned HHS actions under his leadership – ranging from workforce reductions at HHS to spending cuts on scientific research, including research impacting older adults […]
Leadership changes within insurance giant UnitedHealth Group (NYSE: UHG) and its subsidiary Optum have rattled the company from the inside out, with UHG CEO Andrew Witty abruptly resigning on Tuesday, replaced with Chairman Stephen Hemsley who was CEO for UnitedHealth prior to stepping down in 2017. The news comes on the heels of new leadership […]
Therapy in nursing homes has been shaped in recent years by the shift to a patient-centered model, with providers pointing to staff shortages, reimbursement changes, and the influence of Medicare Advantage plans as factors making it harder to tailor programs. Certainly, higher expectations from therapy-based clinical outcomes is changing the therapy market landscape, said Brian […]
The Centers for Medicare & Medicaid Services (CMS) issued a final rule Friday to modernize and improve several Medicare programs, including Medicare Advantage (MA), but it does not include new restrictions on MA plans’ use of artificial intelligence. The rule for contract year 2026, effective June 3, introduces changes to prescription drug coverage, the Medicare […]
A bill to reform prior authorization requirements for Medicare Advantage (MA) – a massive burden that nursing home operators have been trying to change for some time – was reintroduced on Capitol Hill Thursday. Nursing homes have long argued that this aspect of MA needs to be right-sized through legislation. The Reducing Medically Unnecessary Delays […]
For organizations hoping to draw out savings from value-based care, added administrative burdens might be a source of hesitation. However, some operators are successfully turning to technology offerings that maximize reimbursement, pinpoint essential data, and include platforms already used by referral partners and managed care organizations (MAOs). AI programs can help “tease out” some of […]
As president and CEO of Saint Therese Senior Living for the last two years, Craig Abbott has been on a mission to change the idea of wellbeing by strengthening his organization’s workforce and making an urgent case for long-term care and accessibility to nursing homes as a community issue. “We set out a 10-year vision […]
American Healthcare REIT (NYSE: AHR) executives highlighted the strong performance of its Trilogy assets, praising Trilogy’s model for its diversity and flexibility in adjusting to changing market conditions, including possible cuts to Medicaid, and reimbursement for skilled nursing services. Additionally, the executives said that if the proposed Medicaid cuts were to be enacted, Trilogy would […]
A lawsuit against UnitedHealth Group over its wrongful denials of post-acute care under Medicare Advantage plans, including nursing home services, advanced following a court ruling on Thursday. The lawsuit filed in the U.S. District Court for the District of Minnesota claims that UnitedHealth’s use of an AI tool called nH Predict led to arbitrary coverage […]
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