Medicare

AOD acquires Stratis Business Systems, Inc.

AOD Software has bought Stratis Business Systems Inc., a home health and home care cloud-based software system.

Also in the news for July 11, 2014 . . .

Genesis nursing home fired dietary worker due to her disability, government alleges ... Rehabilitation provider groups brief Senators, present findings that IRFs outperform SNFs ... Medicare accounted for the most improper payments the government made last year

Government plan calls for increased surveillance, prosecution to combat elder abuse

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Elder abuse is inflicted upon many of the more than 2 million Americans in long-term care settings, and more oversight is needed, according to a government report published Wednesday.

Panel slams fee for service

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The predominance of fee-for-service payment methods is the greatest barrier to improving efficiency in the nation's healthcare system, according to a May 29 report from a panel of White House advisors. The President's Council of Advisors on Science and Technology criticized the FFS payment model because it focuses on the volume of services provided rather than on better outcomes.

It's time to stop long-term care state rankings

It's time to stop long-term care state rankings

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Minnesota routinely is named best state for long-term care, as it was last week in AARP's 2014 scorecard. AARP held a panel discussion to unveil the rankings, and of course an official from Minnesota was on hand to share his state's secret sauce. But the panel also featured a speaker from Mississippi, one of the lowest-ranking states. I came away thinking that Minnesota actually might not have much to teach Mississippi — and questioning what these types of state rankings accomplish.

 New payment models present opportunities for SNFs

New payment models present opportunities for SNFs

For skilled nursing facilities, the Medicare SNF 3-day rule can make it difficult to place the right patients in the right setting at the right time. The 3-day rule requires that a Medicare beneficiary spend three nights in a hospital as an inpatient — observation stays do not count — before becoming eligible for Medicare-covered SNF care. This rule creates a challenge for SNFs as hospital lengths of stay decline for many of the conditions that SNFs treat.

Hospitalist company with long-term care presence faces federal charges of upcoding

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A hospitalist company that works with thousands of post-acute care facilities is officially facing federal charges that its clinicians routinely overbilled Medicare and Medicaid, authorities announced Tuesday.

Also in the news for June 16, 2014 . . .

Medicare drug procedure could burden dying seniors ... Drugs-then-therapy regimen raises hopes of full stroke recovery ... Docs reaffirm position on long-term care EHRs

Improper coding for doctors' evaluation and management visits costs Medicare billions, OIG report

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Documentation coding errors related to routine patient evaluation and management (E/M) visits are costing the Medicare program billions of dollars in improper payments a year — nearly $7 billion alone in 2010 — according to a new government report. But the investigation involved few claims involving nursing homes.

Dual eligibles more likely to go from hospitals to lower quality nursing homes, referral process might need reform, researchers say

Dual eligibles more likely to go from hospitals to lower quality nursing homes, referral process might need reform, researchers say

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People eligible both for Medicare and Medicaid go to lower-quality nursing homes after being hospitalized at a rate higher than Medicare-only patients, according to researchers from Brown and Harvard universities.

House bill would create site-neutral payments for post-acute care, could save Medicare $100 billion over a decade, lawmakers say

House bill would create site-neutral payments for post-acute care, could save Medicare $100 billion over a decade, lawmakers say

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Federal lawmakers have drafted a bill to implement bundled, site-neutral payments for post-acute services, which they say would save the Medicare program up to $100 billion over a decade.

3 value-based purchasing strategies to help you get ahead

3 value-based purchasing strategies to help you get ahead

Long-term care providers have a stronger hook than they probably realize regarding the toughening of penalties for hospitals with high readmission rates.

Support for Medicare-style, government long-term care insurance program surges, large AP-University of Chicago poll finds

Support for Medicare-style, government long-term care insurance program surges, large AP-University of Chicago poll finds

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The idea of a government-run long-term care insurance program similar to Medicare has become much more popular in the last year, according to the findings of a large nationwide survey. Independent research organization NORC at the University of Chicago and The Associated Press conducted the 1,400-person poll.

Many Americans don't understand long-term care

Many Americans don't understand long-term care

Many Americans remain in denial and are therefore disinclined to pluck the truth from the myths about long-term care, much to the detriment of their own finances as they turn to homecare providers for custodial services on a self-insured basis, if they can afford it. Those who need full-time skilled nursing care end up paying a median of $81,030 per year, according to the Genworth 2012 Cost of Care Survey.

Also in the news for May 14, 2014 . . .

LTC nurses report high emotional and physical burden in end-of-life care for dementia residents ... Medicare paying $2 billion annually on 'wasteful' services ... Clinicians strategies for patient-centered care identified

New wrinkles for population experts — and providers — to consider

New wrinkles for population experts — and providers — to consider

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It's hardly breaking news that we live in an aging nation. But a look inside the latest round of numbers might give providers more reason to feel optimistic about remaining solvent once the age wave hits.

Coordinated care programs: A lifeline for patients and your facility

Coordinated care programs: A lifeline for patients and your facility

If you serve elderly populations in a long-term care or nursing facility, you have my respect — for the compassion you bring to work each day and the challenges you must face.

House bill would expand program to keep younger people out of nursing homes

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People younger than 55 would become eligible for a program to prevent unnecessary nursing home admissions if lawmakers pass a bill introduced Thursday in the U.S. House of Representatives.

CMS: Medicare rate will increase 2% in 2015, boosting skilled nursing facility reimbursements by $750 million

CMS: Medicare rate will increase 2% in 2015, boosting skilled nursing facility reimbursements by $750 million

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Medicare would increase skilled nursing facility reimbursements by $750 million in 2015 under an updated payment rate proposed Thursday. CMS also will begin tying reimbursements to new statistical area designations set by the Office of Management and Budget.

Jimmo implementation is troubled, long-term care expert says

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Skilled nursing providers remain confused about Medicare changes related to the Jimmo v. Sebelius legal settlement, and many beneficiaries are not aware that their therapy might now be eligible for coverage, according to prominent long-term care expert Judith Stein. Stein is an attorney and director of the Center for Medicare Advocacy, which along with Vermont Legal Aid filed the Jimmo case.

Pharmacy owner pleads guilty to paying nursing homes for unused meds in $2 million scheme

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A pharmacy owner in Louisiana bribed nursing home workers to return unused medications, then repackaged and resold them, according to allegations in a $2.2 million Medicare fraud case, state and federal authorities recently announced.

Aggressive lobbying keeps seniors on Lucentis, prevents Medicare savings, USA TODAY article states

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Lobbying efforts have ensured that long-term care residents and other seniors are commonly prescribed the expensive drug Lucentis, even though the less costly drug Avastin has proven equally effective, suggests a USA TODAY article published Thursday. Lucentis in fact has become the No. 1 drug reimbursed by Medicare.

RACs were 'most improved' healthcare auditors for getting back money in 2013, government report states

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Medicare Recovery Audit Contractors dramatically stepped up their overpayment recoveries last year, returning nearly $487 million more to the government than they did in 2012, according to a new report from a federal watchdog agency.

Nursing homes send too many dementia residents to the hospital in their last year of life, study finds

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Nursing homes could do a better job of keeping residents with dementia out of the hospital during their last year of life, suggests recently published findings in Health Affairs.

Same-sex married couples now have expanded Medicare enrollment options, HHS announces

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Seniors now are eligible to receive premium-free Medicare Part A coverage if they are married to someone of the same sex, the Department of Health and Human Services announced Thursday.

Ask the payment expert ... about Medicare technical requirements

Ask the payment expert ... about Medicare technical requirements

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We were told we didn't meet technical requirements for Medicare. What does that mean?

Senate passes 'doc fix' bill that links skilled nursing facility payments to hospital readmissions, delays ICD-10

Senate passes 'doc fix' bill that links skilled nursing facility payments to hospital readmissions, delays ICD-10

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Both houses of Congress now have passed legislation to tie skilled nursing facility Medicare reimbursements to hospital readmissions, starting in 2018. The Senate approved the "Protecting Access to Medicare Act of 2014" in a 64 to 35 vote Monday evening. Prominent long-term care provider associations LeadingAge and the American Health Care Association/National Center for Assisted Living supported the bill.

Sleeper measures could cut Medicare payments to skilled care operators

Sleeper measures could cut Medicare payments to skilled care operators

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As far as skilled care is concerned, most recent reporting on a major Medicare bill has all but overlooked what's in the bill for the sector. And it's not trivial.

Rehab providers offer study results to argue against site-neutral payments

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Patients generally have better clinical outcomes and live longer if they are treated in an inpatient rehabilitation hospital rather than a skilled nursing facility, according to a study commissioned by the American Medical Rehabilitation Providers Association. The findings show why IRFs should be reimbursed at a higher Medicare rate than SNFs, the trade association argued when releasing the results Tuesday.

For-profit hospices serve more extended-stay patients, are more likely to exceed Medicare cap than nonprofits, study finds

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For-profit hospices serve more extended-stay hospice patients than nonprofits, and are much more likely to file claims that exceed Medicare's aggregate annual cap for the hospice benefit, according to newly published findings.

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