Maryland Provider Reaches $2M Settlement Over False Discharge Claims

An extended battle between a now-defunct nursing home operator and the state of Maryland reached a conclusion this week with a $2.2 million settlement. Neiswanger Management Services (NMS) agreed to pay that amount to dismiss allegations that it had improperly discharged Medicare residents and falsely billed the state’s Medicaid program, Maryland Medical Assistance. Back in […]

CMS Moves to Expand Telehealth Coverage Under Medicare Advantage

The Centers for Medicare & Medicaid Services on Friday unveiled a proposal that the agency says will expand telehealth coverage to enrollees in Medicare Advantage plans. Under the proposed rule, which would take effect in calendar year 2020, Medicare Advantage plans could cover telehealth services for both rural and urban enrollees, as well as in-home […]

Medicare’s Impending Death Greatly Exaggerated, But Concerns Remain

Despite concerns about its impending doom, the financial outlook for the Medicare program has improved considerably from where it was 10 years ago. That said, Medicare remains an extremely expensive program, Alicia Munnell and Anqi Chen, both of the CRR, noted in a research brief published last week. “U.S. health care costs as a percentage of […]

Discharges to Skilled Nursing Remain Steady, But Home Health Gains Ground

Hospitals continue to discharge a fairly consistent share of their patients to skilled nursing facilities, but home health has seen a spike in admissions amid a shifting reimbursement landscape and changing consumer preferences. Acute-care hospitals released 22% of their patients into skilled nursing facilities during the first quarter of 2018, according to data released Wednesday […]

Skilled Nursing Providers Have One Shot at Payment Success Under PDPM

Of all the changes coming to the skilled nursing industry when a new payment model takes effect next fall, the most pressing may be one of the most basic: Starting in October 2019, providers will have a single opportunity to set themselves up for financial success with a patient’s initial assessment. The Patient-Driven Payment Model, […]

Signature CEO Steier on the Skilled Nursing Chain’s Rebuild, PDPM, and Industry’s Integrated Future

Skilled nursing provider Signature HealthCARE faced a a series of financial headwinds over the past two years. The provider’s problems ranged from issues paying the rent to major landlords Sabra Health Care REIT (Nasdaq: SBRA) and Omega Healthcare Investors, Inc. (NYSE: OHI) to a government investigation related to the False Claims Act (FCA). The Louisville, Ky.-based operator, […]

Savings Success in ACOs Takes Time, and Risk Might Not Matter

Accountable care organizations (ACOs) need time to work out their growing pains before producing savings for the government, according to a new study from a top health care consulting firm — and a major assumption about risk might not actually be true. ACOs active for four years or longer accounted for just about all of […]

Oklahoma Cities Snap Up Nursing Homes in Gamble for Federal Funds

Several small cities in Oklahoma now hold the licenses to operate dozens of nursing homes in the state, in the hopes of getting funds from a federal bonus payment program offered through the Centers for Medicare & Medicaid Services (CMS), Oklahoma Watch reported this week. Licenses for 46 nursing homes in the state are now owned by […]

CMS Waives Certain Skilled Nursing Rules in Wake of Hurricane Florence

Hurricane Florence prompted skilled nursing evacuations throughout the Eastern seaboard, and the Centers for Medicare & Medicaid Services (CMS) this week issued a series of emergency orders to alleviate the pressure on operators and beneficiaries as they weather the storm. Administrator Seema Verma formally waived the three-day hospital stay requirement for Medicare skilled nursing coverage […]

ACOs Push Back on CMS Savings Estimates In New Analysis

A new analysis from a group of more than 300 accountable care organizations (ACOs) argues that the groups generated much more in savings than official estimates would suggest. The announcement from the National Association of ACOs (NAACOS) claims that ACOs generated gross savings of $1.84 billion for Medicare, almost double the $954 million estimated by […]

ACO Announcements Add to Existing Skilled Nursing Pressures

Value-based arrangements generate much of their savings by shifting spending away from the post-acute setting, according to recent government announcements. That ups the already-high pressure on skilled nursing facilities to lower patient length of stay while maintaining quality of care. To cope, they’ll have to make themselves invaluable to both referral sources and payers who […]

Congressmen Ask CMS to Ease Red Tape for Skilled Nursing Facilities

Two leaders of the powerful House Ways and Means Committee this week asked the Centers for Medicare & Medicaid Services (CMS) to ease regulatory burdens on skilled nursing facilities. In multiple letters to CMS administrator Seema Verma, Rep. Kevin Brady and Rep. Peter Roskam called for reduced compliance burdens for post-acute care providers, hospitals, and […]

Higher Star Ratings Don’t Always Translate to Skilled Nursing Census Gains

For better or for worse, the federal government’s star-rating system for ranking skilled nursing facilities has taken on outsized importance as preferred provider networks narrow and Medicare Advantage plans demand better and better quality. The ratings from the Centers for Medicare & Medicaid Services, therefore, have become a quick and seemingly formal way to separate […]