CLA: For Provider Relief Fund Compliance, the ‘List of Questions Continues to Grow’

The Department of Health and Human Services (HHS) last month released its reporting rules for health care providers who received payments from various COVID-19 relief funds. And according to the professional services firm CliftonLarsonAllen (CLA), there were some curveballs in those rules, which were released September 19 and covered distributions from the CARES Act and […]

As Provider Relief Audits Loom and Scrutiny Increases, Tracing Dollars to Care Vital to Avoid Clawbacks

Health care providers that received more than $750,000 in federal awards from the federal coronavirus Provider Relief Funds (PRF) will face a single audit or program-specific audit, and they need to ensure that the funds are used in accordance with the federal government’s terms and conditions — especially since they can’t be classified as a […]

COVID-19 Scrambles PDPM Math, Particularly Around Therapy Minutes: ‘This Will Be a Complete Rebuild’

In the lead-up to the implementation of the Patient-Driven Payment Model (PDPM) on October 1, 2019, consultants, therapists, and the federal government warned operators over and over that therapy minutes would come under intense scrutiny in the months following the start of the new Medicare reimbursement system. The model allowed for patients to receive up […]

How Nursing Homes Can Bolster Infection Control — for COVID-19 and Beyond

Amid the national emergency caused by COVID-19, infection control in skilled nursing facilities has come under intense scrutiny, with past violations examined under the media microscope — and surveys from the government focused solely on the issue. That scrutiny is only likely to increase due to the challenge nursing homes face trying to contain COVID-19 […]

Skilled Nursing Operators Can Find Success Under the ‘Quite Similar’ PDPM and I-SNP Models

The Patient-Driven Payment Model (PDPM) overhauled the way skilled nursing facilities are paid for their services to Medicare fee-for-service patients when it took effect last year – removing therapy as a driver of reimbursement and putting an emphasis on patient conditions. That gives it more than a passing resemblance to a lightning rod in the […]

Amid Dropping Utilization, Lowest-Performing Nursing Home Margins Fell to -10.2% in Mass.

Massachusetts has been at the forefront of nursing home stress over the last few years, and a new government report illustrated a host of negative statistics — from cratering utilization to median margins as low as -10% for the worst-performing properties. In terms of total resident days, nursing facility utilization in Massachusetts dropped 5.4% between […]

Why the Median Skilled Nursing Margin Fell Below 0% — and How Operators Can Come Up from Underwater

Earlier this fall, a decades-old annual survey of nursing home finances revealed that for the first time, the median operating margin for the nation’s skilled nursing facilities fell below zero. While the statistics from consulting firm CLA weren’t necessarily surprising, given the micro- and macro-level challenges facing nursing home operators over the last decade, that […]

Rethink Podcast #18: Cory Rutledge of CLA

The 18th episode of our podcast, Rethink, is now available! For the first time in 34 years, an annual report on nursing home finances found that the median operating margin for providers fell below zero. For CLA managing principal Cory Rutledge, a co-author of the report, the result wasn’t exactly surprising, given the headwinds battering […]

Number of I-SNP Plans Goes Up Almost 30% Year-Over-Year

The number of skilled nursing providers interested in becoming insurers has grown for the past several months. Now hard numbers show just how great that interest is. Special needs plans are a category within Medicare Advantage (MA) that provide a common framework for the plans that serve special-needs beneficiaries, while also expanding beneficiary choice and […]