CMS: Hundreds More Buildings Could Receive One-Star Staffing Ratings Under New Rules

The new, stricter skilled nursing staffing standards slated for implementation by the federal government next month weren’t entirely unexpected, but they raise questions about the broader problem of understaffed facilities — and hundreds of buildings could be in the crosshairs. The Centers for Medicare & Medicaid Services (CMS) announced March 5 that it would overhaul […]

Providers Can’t Fall for Therapy Myths When Preparing for PDPM

As skilled nursing facilities and rehabilitation providers across the U.S. prepare for the changes to Medicare payments coming in October, they have to make sure they don’t get sidetracked by a slew of misconceptions about what’s coming. That’s according to a Tuesday webinar by clinical management software provider Optima Healthcare Solutions, held in conjunction with […]

CMS to Crack Down on Staffing, Separate Short- and Long-Term Stays in SNF Star Rating Overhaul

The Centers for Medicare & Medicaid Services (CMS) on Tuesday announced stricter standards for its consumer-facing nursing home ratings, including a lower threshold for staffing penalties and new separate ratings for short-term and long-term stays. Starting April 24, CMS will automatically hand out one-star staffing ratings to buildings that have four or more days in […]

OIG Finds $84 Million in Improper Skilled Nursing Facility Payments

The federal government improperly paid skilled nursing facilities more than $84 million for services that did not meet Medicare’s three-day hospital stay requirement, according to a report released Wednesday by the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG). Medicare beneficiaries must stay in a hospital for three consecutive calendar […]

Spending Growth for Skilled Nursing Facilities to Lag Behind Home Health Care

Total spending on nursing care facilities will grow by 5.4% through 2027, according to a new analysis from the Centers for Medicare & Medicaid Services (CMS) — but that figure still lags behind the rate increase for home health agencies. Overall spending on medical care at skilled nursing facilities and continuing care retirement communities (CCRCs) […]

As PDPM Nears, Providers Can’t Rely on Sunny CMS Projections to Succeed

As the implementation date draws nearer for the overhaul of the Medicare reimbursement system, some providers have found comfort in government projections about their revenue under the new model. But that comfort might be misplaced, according to a webinar held Wednesday by Minneapolis.-based consulting and management firm Health Dimensions Group. The Centers for Medicare & […]

CMS Hints at ‘Calling Out’ Nursing Homes Over Quality Problems

A Centers for Medicare & Medicaid Services (CMS) official last week suggested that the public would benefit from more information about resident safety at nursing homes — including the explicit identification of bad actors. Writing in response to a November study about the correlation between Nursing Home Compare star ratings and safety, CMS chief medical […]

CMS Again Moves to Expand Telehealth Coverage Under Medicare Advantage

The federal government on Friday unveiled a series of new test benefits that certain Medicare Advantage plans can offer, including expanded telehealth coverage — marking yet another push toward remote health care benefits. The Centers for Medicare & Medicaid Services (CMS) will implement the programs under the Value-Based Insurance Design (VBID) model, which seeks to […]

CMS Spells Out Expanded Skilled Nursing Waiver Requirements for ACOs

The Centers for Medicare & Medicaid Services (CMS) provided details this week on what accountable care organizations (ACOs) have to do to receive waivers of the three-day inpatient stay requirement for skilled nursing care in updated guidance. ACOs consist of hospitals, physicians, and other health care providers that band together to provide care to Medicare […]

CMS Looks to Expand 3-Day SNF Waivers, Encourage Risk with New ACO Models

The Centers for Medicare & Medicaid Services (CMS) on Friday finalized its new set of rules for accountable care organizations (ACOs), removing the no-risk tracks that represented financial drains on Medicare and expanding three-day stay waivers for nursing homes. Under the new “Pathways to Success” model, most new ACOs will only have two years to […]

CMS Warns of Therapy Scrutiny, Reveals RUG-to-PDPM Transition Details

The Centers for Medicare & Medicaid Services (CMS) on Tuesday provided details on the upcoming transition to the new Medicare payment model for skilled nursing facilities — as well as its key areas of scrutiny as the industry makes the switch. In a Medicare Learning Network call, CMS officials discussed the inner workings of the […]

Growth in Medicare Advantage Spending Far Outpaces Traditional Medicare

The growth in overall spending on nursing homes in the United States slowed for the second consecutive year in 2017, according to the latest analysis from the Centers for Medicare & Medicaid Services (CMS) — while Medicare Advantage spending skyrocketed. All payers spent $166.3 billion at nursing care facilities and continuing care retirement communities (CCRCs) […]

Trump Cabinet Calls on States to Eliminate Certificate of Need Laws

Three prominent members of the Trump administration called on individual states to eliminate Certificate of Need (CON) laws regarding the development of new health care facilities — including nursing homes — characterizing the statues as anti-competitive and detrimental to consumers. Writing in a sweeping, nearly 120-page report on health care reform, the secretaries of the […]

OIG Touts Nearly $3B in Medicare, Medicaid Fraud Recoveries in Fiscal 2018

The Department of Health and Human Services’ top fraud watchdog recovered nearly $3 billion from providers in fiscal 2018, a figure that included more than $18 million in improper payments at nursing homes. The HHS Office of the Inspector General (OIG) touted its $2.91 billion haul in its most recent semiannual report to Congress, released […]

CMS Implements Stricter Nursing Home Staffing Survey Rules for States

The Centers for Medicare & Medicaid Services (CMS) announced Friday that it will use payroll-based journal (PBJ) data to bolster state oversight of nursing homes, effective immediately. Specifically, CMS will use PBJ data to identify and provide state survey agencies with a list of nursing homes that have several days in a quarter without a registered […]

CMS Peels Back Curtain on Why Providers Receive PBJ Audits

As part of the federal government’s effort to verify staffing levels at skilled nursing facilities, skilled nursing facilities are rated on their nursing and caretaking personnel based on payroll records. How the government assesses those records has raised questions among providers, and the Centers for Medicare & Medicaid Services (CMS) recently gave Skilled Nursing News a […]

CMS to Cut Medicare Payments for 73% of SNFs Under Value-Based Purchasing

Nearly three-quarters of skilled nursing facilities will see Medicare reimbursement penalties after failing to hit certain readmission improvement benchmarks, according to a new set of data from the Centers for Medicare & Medicaid Services (CMS) Of the just under 15,000 facilities that reported sufficient data, 73% — or nearly 11,000 buildings — had incentive payment […]

CMS Trumpets Telehealth Potential in Skilled Nursing and Long-Term Care

The Centers for Medicare & Medicaid Services (CMS) issued yet another sign of support for expanding the use of telehealth services in skilled nursing facilities, pointing to a variety of studies that show the technology can save the government money. Writing in a mandated report to Congress released earlier this month, CMS highlighted multiple areas […]

CMS to Use Provider Fines to Develop Nursing Home Safety Resources

The Centers for Medicare & Medicaid Services (CMS) on Tuesday announced an initiative to divert some of the money it collects in provider fines to fund general nursing home improvement initiatives. The three-year Civil Money Penalty Reinvestment Program (CMPRP) will use a portion of nursing home penalty cash to pay for the development of toolkits […]