Medicare Advantage plans forcing providers to take ‘optional’ payment reductions
By
Kimberly Marselas
Nov 15, 2022
Many skilled nursing providers are still underusing Interim Payment Assessments under the nascent Patient Drive Payment Model, but one new pressure is driving some to submit those extra patient evaluations...
Clinical briefs for Thursday, Oct. 6
By
Alicia Lasek
Oct 06, 2022
Projected MA growth to bring more LTC provider headaches … Feds prep for future pandemic, may invest up to $1B in antibody development for flu, other infectious diseases … COVID continues upward trend...
Projected Medicare Advantage growth to bring more provider headaches, more congressional scrutiny
By
Joe Bush
Oct 05, 2022
Several large insurance providers are expanding their Medicare Advantage plans to new states and hundreds more counties, effective in 2023, adding pressure on skilled nursing operators as enrollment booms.
Medicare Advantage enrollees get less post-acute care than traditional beneficiaries: analysis
By
Joe Bush
Sep 19, 2022
Members of Medicare Advantage plans used post-acute care less than people with traditional Medicare, according to an analysis of 62 studies.
‘Death spiral’ for SNFs as Medicare Advantage pay decreases
By
Kimberly Marselas
Sep 06, 2022
Pressure to accept low-ball contracts with Medicare Advantage plans that continue to reduce reimbursement is driving some skilled nursing providers into “a death spiral,” a major aging services association...
Also in the News for Monday, Aug. 29
By
Kimberly Marselas
Aug 29, 2022
New York codifies right of nursing home residents’ estates to sue for damages … Medicare Advantage enrollment hits 28 million, approaching half the total Medicare population … Petition circulates...
I-SNP explosion may be bright spot in Medicare Advantage 5-year trends
By
Kimberly Marselas
Aug 16, 2022
Medicare Advantage’s explosive growth means ever-more pressure for skilled nursing operators, but five-year enrollment data reveals many skilled nursing operators are doing their best to wrest some control.
House committee approves bill that would reform prior authorization under Medicare Advantage program
By
Danielle Brown
Jul 29, 2022
Providers demanding change to the Medicare Advantage program may soon get their wish after a House panel advanced a measure that would reform the program’s prior authorization process.
Providers warned not to interfere with resident healthcare coverage choices after $8 million settlement
By
Danielle Brown
Jul 13, 2022
The nation’s largest nursing home association is urging providers to properly educate staff on acceptable practices when it comes to discussing changes to residents’ healthcare coverage in order to...
Disenrolling residents from MA plans leads to $7.85 million provider settlement with feds
By
Danielle Brown
Jul 01, 2022
A New York-based provider is settling allegations that it switched resident’s Medicare coverage to maximize its reimbursements for nearly $8 million.