Skilled nursing facilities received a 9% Medicare reimbursement boost during the early days of the COVID-19 crisis under the new Patient-Driven Patient Model, a new analysis has determined — providing a crucial fiscal lifeline that may not have existed under the structure that PDPM replaced. “RUG-IV would have been a fiscal disaster for SNFs dealing […]
Zimmet Healthcare Services Group
The federal government took several steps to cut red tape in the health care system to help providers across the continuum battle the COVID-19 pandemic. But while those changes included alterations to reporting requirements for skilled nursing facilities, providers won’t be exempt from the consumer-facing rating system — and they need to be aware of […]
Updated guidelines on the use of personal protective equipment (PPE) are causing major headaches for health care providers across the continuum, as both acute and post-acute care settings grapple with supply shortages and a surge in cases of COVID-19. Those headaches include grappling with significant shortages of equipment in the face of the highly contagious […]
Multiple managed care plans have made changes to their procedures for admissions to the skilled nursing setting amid the ongoing coronavirus pandemic, with several major companies suspending prior authorization requirements for admissions to a skilled nursing facility. The changes, however, are not uniform — and that’s if the managed care organization (MCO) chooses to make […]
The federal government has implemented some key waivers designed to ease health care system burdens, including adopting a waiver of the requirement to have a three-day stay in a hospital to get Medicare coverage of a skilled nursing stay. But some of those waivers have led to confusion among operators — and some of the […]
The early returns for the new Medicare payment model for nursing homes have been broadly positive, with multiple experts and operators pegging the revenue gains at a healthy but modest 5% to 6%. But the actual gains may be higher than those numbers betray, and several experts predict some kind of eventual adjustment from the […]
The new fee-for-service payment model for nursing homes took up most of the oxygen in the industry over the past two years, but the rise of Medicare Advantage in markets across the country could make all of that preparation for naught — sooner than many may think. The Patient-Driven Payment Model (PDPM) for nursing homes […]
Despite steady reports of increasing reimbursements under the new Medicare payment model for nursing homes, at least one industry leader believes that the federal government will be happy with the early returns — and that any changes are fairly far down the road. Skilled nursing operators have not gone overboard with the strategy changes that […]
It’s four months into the Patient-Driven Payment Model (PDPM), and despite some industry analysts pointing to early gains for nursing homes, many occupational, speech, and physical therapy advocates continue to criticize layoffs and changes to resident care patterns. On the operational side, the initial PDPM returns have been positive: For instance, 67% of nursing homes […]
The latest analysis of the new Medicare payment model for nursing homes again shows more operators scoring gains than suffering losses, but the change from the previous system may not be quite as straightforward — particularly as fee-for-service Medicare continues to lose ground to other payment sources. A little more than 67% of skilled nursing […]
A new non-profit society aims to improve education for purchasing directors at post-acute facilities, so they can make better decisions for both the bottom line — and for their long-term future. The approach the organization — the Society for Healthcare Organization Procurement Professionals (SHOPP) — is taking is two-pronged, according to Ari Stawis, director of […]
The new year is barely a few days old, but leaders across the post-acute and long-term health care space have already predicted an active — and potentially distress-filled — 2020. As the industry adapts to a new Medicare payment model, the pressures that have bogged operators down over the last few years will continue, from […]
Early PDPM Claims Data Reveals Far More Winners Than Losers, ‘Impossible Combinations’ of Conditions
The first round of claims data under the new Medicare payment model for nursing homes shows that the majority of operators are seeing reimbursement boosts — while some are also making key billing mistakes that could result in missed payments for certain services. The average skilled nursing facility saw Medicare reimbursements of $614.96 per patient […]
Skilled nursing providers looking for a simple answer to how managed care plans will react to the new Medicare payment model will likely have to face an inconvenient truth: It’s complicated. Private Medicare Advantage insurers didn’t have to follow the old Resource Utilization Group (RUG) model when deciding how to reimburse for skilled nursing services, […]
Faced with a sea change in the Medicare reimbursement system for nursing homes, operators have spent the last year asking a key question about their therapy offerings: outsource or in-house? And if the answer is outsource, what will that relationship look like moving forward in unfamiliar payment landscape? There’s no one correct answer for contract […]
Data continues to be the watchword in a skilled nursing marketplace where hospitals and other referral partners demand increasingly concrete information about post-acute outcomes. In response, numerous tech companies have stepped into the fray to provide potential solutions — from data analytics tools that can identify serious health issues before they escalate to a hospitalization, […]
Skilled nursing operators frequently bemoan the shorter lengths of stay and lower daily payment rates for Medicare Advantage residents, but the leader of one plan says it’s also up to providers to present novel ideas to insurance executives. Before taking the CEO role at the nursing-home focused Longevity Health Plan earlier this year, René Lerer […]
The new Medicare payment model for skilled nursing facilities has consumed most of the oxygen around the industry over the past year-plus, with operators, vendors, and consultants working in tandem to adjust to the new math. But according to one leader, all of that attention on the Patient-Driven Payment Model may not be focused on […]
Accurately diagnosing and treating depression could bring significant rewards for operators under the new Medicare payment model for nursing homes — both financially and clinically. Training frontline caregivers to notice the signs of depression among residents of skilled nursing facilities will be vital to success under the coming Patient-Driven Payment Model (PDPM), according to Zimmet […]
Several states across the U.S. have eyed managed long-term services and supports as a way to reduce their Medicaid spend, but the state of New York — which made the move in the early part of the decade — is now taking a step back. Specifically, the Empire State is looking to move the long-term […]