When looking at the 4.2% Medicare increase in the Skilled Nursing Facility Prospective Payment System (SNF PPS) for 2025, some leaders in the space wonder if the rate calculated has been inadequate considering inflation, labor woes, and funds needed to meet the federal staffing mandate. Some even argue that rate increases are so far behind […]
As the Medicaid payment system transitions across states from RUGS to the Patient-Driven Payment Model (PDPM), nursing home operators must be wary of misconceptions – including that the transitions will always lead to additional Medicaid funds being available – while putting in place the right practices to ensure appropriate payments. The complexities of Medicaid transitions […]
Nursing home operators say the civil monetary penalty (CMP) expansion is proving to be one of the most problematic features of the 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule. Initially, there was excitement for the Medicare payment increase, but this has turned to dread for operators who are already dealing with […]
The Centers for Medicare & Medicaid Services (CMS) late Wednesday finalized its 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) rule, approving a net increase of 4.2%, or approximately $1.4 billion in Medicare Part A payments for next year. The increase is calculated based on the SNF market basket percentage increase of 3%, plus […]
Meticulous documentation is the name of the game for nursing home operators looking to keep up with Minimum Data Set (MDS) changes and maintaining a good rating in the Five-Star Quality Rating System. This is especially because inaccurate or insufficient data could affect a facility for at least a year in the future. Leaders in […]
In recent years, nursing homes have faced increased scrutiny and litigation, often driven by data that can be misunderstood or misrepresented. To secure themselves, nursing homes must leverage a data strategy, ensuring accurate documentation and clear communication of their data story to legal experts and stakeholders. This approach can mitigate risks, clarify misunderstandings, and showcase […]
While it’s widely understood that the 5-Star ratings for nursing homes don’t always accurately reflect the true performance of a facility in real time, or even in a timely manner, less attention has been given to the financial and legal headaches the rating system has created for both providers and consumers alike. The complexities that […]
Hundreds of nursing homes continue to maintain or display high star ratings despite Immediate Jeopardy incidents in the previous three years, and this can create headaches for both nursing homes and consumers alike. According to a Scripps News analysis released Wednesday, which takes in to account government data from February 2024 of more than 14,000 […]
While Medicare Advantage (MA) has grown steadily in the last several years, leaders in the nursing home sector speculate whether increased federal regulation – and perhaps even more importantly, changes in the consumer experience – will slow its growth. This would come as a welcome development to many nursing home leaders, who have been struggling […]
Conspicuously absent data on Medicare Advantage (MA), along with stagnated data collection overall by government agencies, should give nursing home operators cause for concern especially as this trend has influenced company advocacy and negotiating power when it comes to insurance plans. Having this data and understanding how it’s calculated can help operators “speak the same […]
As Medicare Advantage continues to grow in the skilled nursing space, beneficiaries utilizing traditional Fee-For-Service Medicare have declined, and in turn reimbursement has dropped at an alarming rate. For every two beneficiaries that opted for MA, one FFS individual left the program in 2023, the first year the number of FFS beneficiaries declined in every […]
The Covid-19 pandemic’s labor crisis forced some nursing home providers to adapt their business practices in 2023, during a time some leaders termed the “year of recovery.” And, as they look ahead to 2024 amid a looming federal staffing mandate, many nursing home providers look to gain from these efficiencies – but are fearful about […]
Margins squeezed by interest rates and inflation, staffing shortages amid a draconian staffing mandate proposal, an invasion of Medicare Advantage and mixed efforts at adapting to Minimum Data Set (MDS) changes are among a litany of the challenges facing the skilled nursing sector at the start of 2024. However, all is not doom and gloom […]
In adjusting to new case-mix systems under the Patient Driven Payment Model (PDPM), the changes to reimbursement rates might be more widespread and large-scale than anticipated, posing financing threats to the nursing home sector because lenders are basing loans on rate projections that are expected to be scaled back. The goal of budget neutrality – […]
More guidance is available on how to conduct mood interview changes, with the Centers for Medicare & Medicaid Services (CMS) updating the Resident Assessment Instrument (RAI) manual to reflect key changes in the new Minimum Data Set (MDS). Notably, if a resident refuses or is unwilling to participate in the interview, assessors need to go […]
Ahead of the upcoming Minimum Data Set (MDS) changes on Oct. 1, the preparation of clinicians is mixed and may have a lot to do with company size and regional market, along with resources to stay apprised of reimbursement updates. Many clinicians feel stressed and overwhelmed by the adjustments, with some playing catchup to the […]
A big question that operators must ask themselves when considering involvement in an institutional special needs plan, or I-SNP, is ultimately wrapped up in how much money is being made on the Medicare Part B therapy side, some say. It might not make financial sense to sign up for an I-SNP if a SNF operator […]
Although survey citation rules can vary from state to state, nursing home operators can implement broad steps to avoid deficiencies if they focus on the often overlooked easy fixes as well as the more complicated overlaps between disparate areas of care – ranging from food safety and mental health documentation to infection control. Certain trends […]
Covid cases are beginning to rise again, steadily at first and now with a sharper increase over the past five weeks, especially in large metropolitan areas. Hospitalizations across the country rose by nearly 19% in the last week to 15,067, according to data from the U.S. Centers for Disease Control and Prevention. This is especially […]
Industry leaders continued to have mixed reactions about the fate of the Biden Administration’s nursing home staffing mandate after the accidental online release of a staffing study commissioned by the Centers for Medicare & Medicaid Services (CMS), with some insiders questioning the leaked study’s data. Industry stakeholders doubted the reliability of the study conducted by […]
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