Full Medicare Part A Funding Will Run Out in 2026, Two-Thirds of SNFs in the Red by 2040

The trust fund that supports Medicare Part A coverage will run out of money to cover full benefits in just seven years, the federal government announced on Monday, with potentially devastating long-term effects for the majority of nursing home operators. The Hospital Insurance (HI) Trust Fund, which directly supports Medicare Part A benefits — including […]

CMS Shares Strategies for Successful Collaborations Between ACOs, Nursing Homes

The federal government released a breakdown of strategies that accountable care organizations (ACOs) have used to successfully partner with skilled nursing facilities — a move that could indicate policymakers’ continued support of the care models. The Centers for Medicare & Medicaid Services (CMS) recently released a care coordination toolkit for ACOs that drew from focus […]

GAO: CMS Must Strengthen State-Level Oversight of Skilled Nursing Facilities

For at least 15 years, the Centers for Medicare & Medicaid Services (CMS) failed to deal with gaps in the federal oversight of nursing home abuse investigations in Oregon, the U.S. Government Accountability Office (GAO) determined in a management report released on Monday — and officials want a review of state-level rules nationwide. CMS oversees […]

CMS Finalizes Expanded Medicare Advantage Telehealth Coverage

The Centers for Medicare & Medicaid Services (CMS) on Friday finalized new guidance that will allow Medicare Advantage plans to expand coverage of telehealth services. Beginning in plan year 2020, Medicare Advantage providers can include telehealth services as part of their basic benefits to enrollees, moving remote doctor visits from an optional add-on to a […]

CMS Launches $1M AI Development Challenge Aimed at Predicting Unnecessary SNF Admissions

The Centers for Medicare & Medicaid Services (CMS) on Wednesday announced an open challenge to tech providers, dangling $1 million for the algorithms that can best predict potential admissions to skilled nursing and other health facilities. With the Artificial Intelligence Health Outcomes Challenge, CMS hopes to entice tech firms and individuals to compete against each […]

Crackdown on Improper Medicare SNF Payments May Cost More Than It Saves

The Department of Health and Human Services (HHS) made a splash last month when it claimed that skilled nursing facilities received $84 million in Medicare payments for treatments that didn’t qualify — but now a group of doctors claims that the proposed cures might be worse than the disease. Writing in a blog post for […]

Deadline for SNFs to Dispute Value-Based Penalties Nears — But Some Claims May Be Too Old

Skilled nursing facilities officially have until the end of March to submit corrections related to their quality measure information under the SNF Value-Based Purchasing (VBP) program, which offers incentive payments for facilities that reach certain readmission benchmarks — as well as penalties for those that fail. But it might not be possible to complete the […]

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 & […]