Medicare

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.

When numbers are drawn out by healthcare auditors and red flags wave

When numbers are drawn out by healthcare auditors and red flags wave

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The takeaway in a story last week about extrapolation and Medicare overpayments is, natch, how meticulous providers should be when filing claims — and to understand how individual claim problems can grow. And, boy, can they grow.

Medicaid-only long-term care residents driving up state expenditures, report finds

Medicaid-only long-term care residents driving up state expenditures, report finds

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Among people eligible for Medicaid but not Medicare, long-term care residents are most likely to be among the costliest beneficiaries for a state, according to a new report from the Government Accountability Office. Sen. Charles Grassley (R-IA) requested the report, noting that much research has focused on those eligible for both Medicaid and Medicare, but has largely overlooked the Medicaid-only group.

More than 20% of Medicare beneficiaries seek hospital care within a month of nursing home discharge, researchers find

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A large number of rehabilitation patients seek hospital care shortly after being discharged from a nursing facility, according to recently published research.

Congress passes a bill to extend Medicare cuts an additional year

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The Senate has passed a bill to extend 2% cuts to Medicare reimbursements for an additional year, and the measure now is headed to the White House for President Obama's signature.

Docs might get a raise, and long-term care might get a bill

Docs might get a raise, and long-term care might get a bill

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Major League teams don't celebrate World Series victories midway through the season. But politicians do the equivalent all the time. Consider a revised Medicare payment plan that was joyously unveiled on Thursday.

Telemedicine reduces nursing homes' hospital readmissions if staff engagement is high, researchers find

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Skilled nursing facilities that implement a telemedicine service and teach staff to use it could reduce their hospital readmissions, but current payment systems do not encourage this, according to a forthcoming study in Health Affairs.

Post-acute Medicare spending varies by location and how an episode of care is defined, CMS report shows

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A Medicare expenditure for an episode of post-hospital care in 2008 ranged from about $5,700 to $14,500, depending on how the episode was defined, according to a new report from the Centers for Medicare & Medicaid Services.

Gap between long-term care costs and Medicaid payments was widest ever last year, report finds

Gap between long-term care costs and Medicaid payments was widest ever last year, report finds

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Medicaid underfunded long-term care by the greatest margin on record in 2013, according to a new report from the American Health Care Association/National Center for Assisted Living, the nation's largest long-term care provider association.

CMS: Nursing home Medicare cuts helped keep healthcare spending at historic low levels

CMS: Nursing home Medicare cuts helped keep healthcare spending at historic low levels

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Dramatic Medicare cuts to skilled nursing facilities played a significant part in keeping healthcare spending low in 2012, the Centers for Medicare & Medicaid Services announced Monday.

The safety net for seniors

The safety net for seniors

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Healthcare reform, especially the expansion of Medicaid, will bring into focus the fragility of the safety net. This is a system that is for vulnerable seniors, but which has not been adequately financed.

Bill eases 3-day rule for many operators

Bill eases 3-day rule for many operators

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Above-average skilled nursing facilities may become exempted from Medicare's prior hospitalization requirement, per legislation from Rep. Jim Renacci (R-OH).

Many seniors rely on devices to live independently, study finds

About a quarter of Medicare beneficiaries rely on walkers or other assistive devices, according to a new study. Women were more likely than men to use devices.

House bill would offer lump-sum Medicare payments to hospitals, post-acute providers

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Skilled nursing facilities and other post-acute providers would be eligible to participate in a Medicare bundled payment system proposed in a House of Representatives bill unveiled Thursday.

Congress passes budget that would extend Medicare cuts, soften sequestration

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A bipartisan budget deal is on the verge of becoming law, after being passed by the U.S. Senate in a 64-36 vote on Wednesday. Long-term care leaders called for passage of the two-year spending plan after it was released last week, saying it will provide needed stability and end the type of political brinkmanship that closed the government in October.

Newly endorsed quality measure assesses Medicare costs for a whole episode of care

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The National Quality Forum has endorsed a controversial hospital quality measure that assesses Medicare costs for a whole episode of care, including time spent in post-acute settings, the organization recently announced.

MedPAC recommends reimbursement freeze for hospice providers

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Policymakers should freeze Medicare hospice reimbursements for 2015, according to recommendations supported by the Medicare Payment Advisory Commission.

Doctor admits kickback role in sending homeless people to nursing homes, hospitals

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A California physician received kickbacks from skilled nursing facilities as part of a large-scale scheme to defraud government health programs, authorities announced Friday. Ovid Mercene, M.D., pleaded guilty to the fraud and related tax charges in U.S. District Court.

First-ever CDC report: Nursing homes provide most long-term care nationwide, alternative settings gain ground in the West

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Nursing homes still account for the vast majority of long-term care services available in the United States despite policies meant to encourage home- and community-based care, according to a new government report. The first-ever "National Study of Long-Term Care Providers" includes data on the capacity and operational characteristics of providers, and information about the people cared for in these settings.

Senators advance bill to repeal Medicare outpatient therapy caps, physician payment formula

Senators advance bill to repeal Medicare outpatient therapy caps, physician payment formula

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The Senate Finance Committee has advanced a bill that would repeal the Medicare Part B cap on therapy reimbursements and replace it with a new outpatient therapy payment system.

MedPAC renews call for long-term care payment cuts, draws fire from providers

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The Medicare Payment Advisory Commission has recommended a 4% reduction in skilled nursing facility payments in 2016, prompting an outcry from providers.

Ryan, Murray strike budget deal that would extend Medicare sequestration cuts

Ryan, Murray strike budget deal that would extend Medicare sequestration cuts

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Top House and Senate budget negotiators have carved out a deal that would end many parts of the across-the-board spending cuts known as sequestration, but long-term care providers would face an additional two years of reduced Medicare reimbursements.

CMS updates Medicare manual to reflect Jimmo settlement

CMS updates Medicare manual to reflect Jimmo settlement

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The Centers for Medicare & Medicaid Services has revised the Medicare Benefit Policy manual to clarify that skilled care and skilled therapy may be covered even for conditions that will not improve, per the settlement in the high-profile Jimmo v. Sebelius case.

Dedicated observation stay units could protect nursing home benefits, save hospitals $1 billion annually, researchers say

Dedicated observation stay units could protect nursing home benefits, save hospitals $1 billion annually, researchers say

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Specialized hospital units for patients under observation status could dramatically reduce the number of seniors forced to pay out-of-pocket for skilled nursing care, according to findings in the current issue of Health Affairs.

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