Medicare

NJ physicians to face charges that they kept people as inpatients to qualify them for SNF coverage, judge rules

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A whistleblower can continue to pursue charges that a number of New Jersey physicians improperly designated Medicare beneficiaries as inpatients and sometimes prolonged their hospital stay to qualify them for skilled nursing care, a federal judge recently ruled.

Redoing readmissions

Redoing readmissions

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When people are discharged from the hospital following an illness, injury or surgery, that's often not the end of the story.

DOJ forces observation stay showdown

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Hospitals have been cast in a harsh light by long-term care advocates recently for allegedly over-using "observation stay" status. The practice can ultimately deny some patients subsequent Medicare coverage for nursing home admission.

Rate hike will be only a part of the new Medicare reality

Rate hike will be only a part of the new Medicare reality

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Many providers are relieved that Medicare rates are slated to go up by 2% in the next fiscal year. After all, who wants to turn down $750 million, especially in a rate-cutting climate?

Scrap hospital rule: experts

Scrap hospital rule: experts

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Medicare should cover people who go to a skilled nursing facility without a preceding hospital stay, experts recently told the Senate Special Committee on Aging.

Medicare rates will increase 2% in 2015

Medicare rates will increase 2% in 2015

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When is a meager pay hike viewed as welcome news? When the source of that increase — namely, the federal government — seems intent on making cuts almost everywhere else.

Federal court dismisses whistleblower lawsuit over Omnicare, PharMerica withholding generic drugs

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A federal court in New York has tossed a whistleblower lawsuit charging that large long-term care pharmacies violated the False Claims Act by failing to dispense requested generic drugs.

Also in the news for August 12, 2014 . . .

NY man suspected of trying to smother nursing home resident ... Medicare agency publishes QIO evaluation criteria ... TX nursing home deaths raise questions about mentally ill residents

Why be optimistic when anxiety is an option?

Why be optimistic when anxiety is an option?

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Depending on how you like to interpret the news, nursing home operators are either facing some of the worst of times, or they've been infused with new life.

60 seconds with ... Avalere Health Director Brian Fuller

60 seconds with ... Avalere Health Director Brian Fuller

Q: The government is notifying new participants in the Bundled Payments for Care Improvement initiative. Do you expect more post-acute providers in this latest round?

Medicare SNF rate finalized, reimbursements to increase by $750 million next year

Medicare SNF rate finalized, reimbursements to increase by $750 million next year

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Medicare skilled nursing facility reimbursements will increase by $750 million next year under a final payment rule announced Thursday by the Centers for Medicare & Medicaid Services.

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.

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