Nine skilled nursing facilities and a pair of consulting firms will pay the federal government $10 million as part of a deal to settle allegations of false Medicare claims. Southern SNF Management Inc., Rehab Services in Motion dba Dynamic Rehab, and nine related SNFs in Florida and Alabama were accused of providing unnecessary therapy services […]
The Centers for Medicare & Medicaid Services last week announced a new database that its leaders claim will help foster a more seamless transfer of data between post-acute care facilities. The Data Element Library (DEL) will allow the public to access various data points that providers are required to report to CMS — including demographic […]
As referral networks narrow and skilled nursing providers feel increased pressure to prove their worth to hospitals and doctors, one government agency says residents still frequently miss the highest-quality options in their own areas. In its most recent report to Congress, the Medicare Payment Advisory Commission (MedPAC) asserts that many hospitals discharge post-acute care patients […]
Health and Human Services Secretary Alex Azar on Tuesday trumpeted the new payment model for skilled nursing facilities in a speech before a prominent trade group, positioning the plan as one piece of a larger change in the way the government pays for health care. The new Patient-Driven Payment Model (PDPM) incorporates the dual goals […]
A group of 17 state attorneys general this week asked the Centers for Medicare & Medicaid Services to reconsider decisions they claim reduce federal oversight of nursing homes and put seniors at risk. The officials specifically took issue with CMS’s November 2017 decision to delay enforcement of the new Requirements of Participation (RoPs) for 18 […]
While skilled nursing operators have increasingly faced stresses related to the ongoing shift to value-based care — primarily the threat of decreased reimbursements — at least one observer says the industry hasn’t seen anything yet. “You’re just entering the value-based dynamic right now,” Mountasser Kadrie, a health care management consultant, said during a presentation at […]
The state of New Mexico ranks at the bottom in terms of serious skilled nursing deficiencies per facility, according to a recent analysis conducted by a pair of news organizations. Out of the 74 facilities in the state certified by the Centers for Medicare & Medicaid Services, 36 had “serious deficiencies” between 2015 and 2018, […]
As the skilled nursing industry continues to digest the effects of the new Medicare proposed payment system, one CEO says that Medicare Advantage can provide a path forward. The new Patient-Driven Payment Model (PDPM) isn’t all that different from the way managed Medicare plans expect operators to provide services and bill for their time, Genesis […]
A federal lawmaker on Wednesday rolled out a plan to provide a long-term care benefit as part of Medicare, citing the aging U.S. population and skyrocketing costs. Rep. Frank Pallone, a New Jersey Democrat, unveiled the Medicare Long-Term Care Services and Supports (LTSS) Act, a discussion draft of a bill that would expand Medicare coverage […]
The Centers for Medicare & Medicaid Services (CMS) shook the skilled nursing world last week by rolling out a proposal for a new payment model, replacing the structure that the industry had been anticipating for a year. But several experts say that operators should look at the changes as positive updates made with providers in […]
The Centers for Medicare & Medicaid Services (CMS) on Friday unveiled a new proposed model for skilled nursing reimbursements that the agency says will save providers $2 billion over the next decade. The proposed Resident Classification System, Version I (RCS-I) is out, and the Patient Driven Payment Model (PDPM) is in, with an effective start […]
The Department of Health and Human Services (HHS) filed an objection to Orianna Health Systems’ bankruptcy plan, bringing the case into unsettled legal terrain. U.S. Attorney Erin Nealy Cox this week argued that HHS and the Centers for Medicare & Medicaid Services (CMS) have the ultimate control over the legal issues surrounding the transfer of […]
The Center for Medicare & Medicaid Innovation (CMMI) has a new director. Adam Boehler, founder and former chief executive officer of home health provider Landmark Health, was named CMMI director — a position that also comes with the title of deputy administrator — by Department of Health and Human Services Secretary Alex Azar. Azar has […]
Changes to the way Medicare reimburses providers of therapy services will change the game for skilled nursing operators, at least according to one industry analyst. The Resident Classification System, Version I (RCS-I) will replace the current fee-for-service Medicare therapy structure with a model that more closely tracks with larger trends toward value-based services, rewarding providers […]
While individual star ratings are important for skilled nursing providers, a high number doesn’t always mean they are providing the best care and seeing lower rehospitalization rates. As the skilled nursing industry continues to adapt to new value-based care models, the importance of the Five-Star Quality Rating System from the Centers for Medicare & Medicaid […]
More than 60% of outpatient therapy claims filed over a six-month period didn’t meet Medicare’s requirements — a figure that has a key government watchdog agency concerned. The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) looked at a representative sample of 300 Medicare therapy claims filed in the final […]
With managed plans gobbling up an increasing share of Medicare enrollees, skilled nursing executives need to gain fluency in the language of insurance providers — or risk being left behind. That was the message from a recent panel discussion at the National Investment Center for Seniors Housing & Care (NIC) Spring Investment Forum in Dallas, […]
A pair of United States senators asked new Health and Human Services Secretary Alex Azar to focus on developing alternative payment models for Medicare — while moving away from traditional fee-for-service (FFS) Medicare. “As the largest purchaser of health care in the United States, the federal government needs to send a strong signal that paying […]
In a Valentine’s Day letter to top health officials, a group of influential Senate Democrats asked the Centers for Medicare & Medicaid Services (CMS) to reconsider certain rollbacks of nursing home regulations. In response, a leading industry group on Wednesday wrote back to the senators to clarify and rebut some of their points. “We think […]
Accountable care organizations (ACOs) only generate savings for the government if they accept risk, according to an analysis from the Kaiser Family Foundation. ACOs generated net savings of $47 million in 2016, the Menlo Park, Calif.-based non-profit found in an independent analysis of publicly available ACO data and previously unpublished numbers from the Centers for […]
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