A Medicare Advantage bundled payment model for hip and knee replacements offered by Humana (NYSE: HUM) was associated with reduced skilled nursing facility use. These bundled payments were also linked to reduced spending overall for lower extremity joint replacements (LEJR) – while maintaining quality of care, according to a study published in JAMA Network. Of […]
Category: Medicare
Concerns about lack of skilled nursing access for cancer patients, as well as oncology-related costs borne by skilled nursing facilities, have prompted operators to call for action from the Centers for Medicare & Medicaid Services (CMS). Several nursing home professionals raised this issue in comments to CMS’ proposed Medicare payment update for 2024. One oncology […]
Following the Centers for Disease Control and Prevention (CDC) recommendation to administer the RSV vaccine to seniors aged 60 and older, HHS Secretary Xavier Becerra issued a statement Friday backing the recommendation. Becerra said the move will ensure stronger protection for nursing home residents ahead of winter months. The vaccines are the first licensed in […]
Owners, operators and landlords of Centers Health Care in New York are facing a lawsuit filed by the state Attorney General Letitia James on Wednesday, which alleges the four SNFs illegally misused more than $83 million in taxpayer money. Diverted funds went toward, among other things, funding the purchase of Israeli airline El Al, according […]
Moving ahead with its reform initiatives to make nursing home ownership more transparent, the Centers for Medicare & Medicaid Services (CMS) on Wednesday began posting names of affiliated owners and aggregate data related to staffing and other metrics for ownership groups. The agency made the information available on Nursing Home Care Compare and data.cms.gov; consumers […]
A higher employment of physicians and advanced practitioners at nursing homes – or SNFists – isn’t associated with statistically significant changes in rehospitalization rates. Instead, facility adoption of these SNFists may represent a strategy by nursing homes to maintain rehospitalization rates as operators attempt to shift patient case mix in favor of those receiving post-acute […]
As rising acuity and reimbursement challenges stymy nursing home workforce growth, third party contracts have been increasingly responsible for providing daily services. Whether its providing resident-facing clinical work, including use of third party doctors, supplying medical equipment or rendering back office services that focus more on ensuring proper documentation for reimbursement, third parties are increasingly […]
As hospital advocates criticize low reimbursements to nursing homes and home health, the Centers for Medicare & Medicaid Services (CMS) is bearing down on hospitals to revamp their discharge process when releasing patients to SNFs. Citing areas of concern related to missing or inaccurate patient information upon discharge, CMS is requiring that hospitals have an […]
The Centers for Medicare & Medicaid Services’ (CMS) comment period on the SNF proposed rule ended with only 74 comments posted from skilled nursing stakeholders Monday. For perspective, last year’s comment period garnered about 4,700 comments. The drastic decline in comments reflects a sense of appeasement with the new rulings. Providers in 2022 faced a […]
Medicare overpaid physicians serving in facility settings during a two-year audit period – about $22.5 million more for over a million claims. That’s according to an audit conducted by the Office of the Inspector General (OIG) and published this week. Generally, Medicare pays practitioners for physician services separately – and a higher amount – compared […]
As value-based care increasingly becomes more prevalent in the nursing home industry, providers continue to straddle traditional Medicare fee for service (FFS) and a plethora of managed care plans. But there are arrangements that can allow organizations to be both payer and provider, or partner with those that already occupy both worlds. Amy Kaszak, executive […]
As acuity continues to rise among nursing home residents, providers say reimbursement needs to change too – and not just the dollar amount. Incentives should be based on quality of care, and the industry will need to build out specific reimbursement models to match expanded acuity specialities, especially as value-based care becomes more and more […]
Skilled nursing facilities can expect three finalized measures, along with several proposed measures for future years related to the value-based purchasing program, the Centers for Medicare & Medicaid Services (CMS) officials said Wednesday. The various measures include stipulations connected to quality, staffing turnover, resident falls and discharges. Chris Palmer, SNF VBP program coordinator with CMS, […]
As promised, the Centers for Medicare & Medicaid Services (CMS) late Monday released virtual training on updated guidance for the Minimum Data Set (MDS). The agency initially announced plans for training sessions during an open door forum in March. Part one consists of pre-recorded training webinars to deliver foundational knowledge on changes coming Oct. 1. […]
All skilled nursing facilities that participate in Medicare Fee-for-Service (FFS) can expect a letter from the Centers for Medicare & Medicaid Services (CMS) regarding improper payment rates starting June 5. And, as of an updated memo from CMS on Monday, claims could be adjusted or denied if an improper payment is identified. CMS initially posted […]
The Centers for Medicare & Medicaid Services (CMS) took aim at improper skilled nursing payment rates in its latest memo on May 4. This appears to be a reaction from data compiled using the Comprehensive Error Rate Testing (CERT) program, which projected an improper payment rate of 15.1% in 2022 for Medicare Fee-for-Service (FFS), nearly […]
Medicare fee-for-service (FFS) admissions increased among skilled nursing facilities by 5.8% in 2022, while other care settings saw a decrease in this metric, and as SNF utilization rates increased nationwide. However, quarterly skilled nursing admissions still decreased faster than FFS enrollment. That’s comparing 2019 and 2022 directly, according to Trella Health’s annual industry trend report […]
Nursing home operators may see a long phase-in for a federal minimum staffing requirement, and a host of exceptions, when more details finally come – but, it’s difficult to speculate on hypotheticals and may not help operators to dwell on the “what-ifs.” That’s according to Ensign Group (Nasdaq: ENSG) CEO Barry Port, who weighed in […]
The Centers for Medicare & Medicaid Services (CMS) on Monday dropped the eagerly anticipated optional state assessment (OSA) for nursing homes, as a supplement for operators to fill out in states still transitioning to the Patient Driven Payment Model (PDPM). If a state decides not to transition to a PDPM-based Medicaid case mix with the […]
As the skilled nursing industry steadily moves toward an Oct. 1 deadline for changes to the Minimum Data Set (MDS), operators are stressing the importance of training staff to help accurately code under the new system, a byproduct of the switch to the Patient Driven Payment Model (PDPM). While details of the most notable shift […]
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