Medicare/Medicaid

Are you ready for PBJ transactions?

With the new CMS reporting requirements looming, skilled nursing facilities are gearing up for the mandatory Payroll-Based Journal data transactions for direct-care workers. Read More »

CMS proposes payment boost, new reporting system for hospice

Hospice may see a 2 percent increase in reimbursements in 2017, but new reporting requirements could go into effect as well, according to a new CMS proposal. Read More »

Fast food threatens to steal LTC workforce in Texas

Texas has one of the highest turnover rates for nursing home employees. The facilities are having trouble staying competitive with Wendy’s or McDonald’s, which can offer hourly workers a job with better pay and less stress.  Read More »

Rocking the drug reimbursement boat

Medicare is trying a new way of calculating the reimbursement for certain drugs, including expensive drugs to treat cancer. After barely a month, the pilot has riled physicians on both sides of the issue. Read More »

CMS payment model could change primary care for up to 25M Medicare beneficiaries

The Centers for Medicare and Medicaid Services (CMS) will test a new payment model that encourages doctors to focus on health outcomes rather than volume of visits or tests. Read More »

DOJ: substandard nursing home care will not be tolerated

The Department of Justice announced the launch of 10 regional interagency task forces designed to protect seniors in nursing homes by holding operators accountable for the quality of care they provide. Read More »

CMS imposes fines of more than $278k for Woodbriar Health Center

The Centers for Medicare & Medicaid Services has imposed steep fines and threatened to terminate Woodbriar Health Center from its programs if serious problems are not resolved by next week. Read More »

Innovation program to reduce nursing home hospitalizations

The Center for Innovation has invested more than $30 million for Indiana University’s project to reduce avoidable hospitalizations for nursing home residents by providing higher levels of care on site. Read More »

Calif. nursing home population growing younger

From 1994 to 2014, the population of California nursing home residents under age 65 increased by nearly 40 percent. So, too, did the number of reported problems directly related to the resident population mix.   Read More »

Fla. passes LTC wait-list prioritization law

The new law will require the state’s Department of Elderly Affairs to sort and prioritize those who are receiving long-term care services and those who are waiting for consideration. Read More »

Proposed legislation aimed at comorbidity among Medicare beneficiaries

A U.S. Senate Working Group has outlined priorities for improving Medicare delivery to beneficiaries with multiple, complex chronic illnesses while reducing healthcare expenditures.  Read More »

CMS solicits advancements, interventions in care delivery through Special Innovation Projects

The Centers for Medicare & Medicaid Services seeks ideas for improving care delivery through a Special Innovation Program and will offer 28 awards totaling $8 million. Statements of Objectives will be available early April.  Read More »

Government to add nearly 6,000 updates to ICD-10

The CDC and CMS announced they will celebrate the one-year anniversary of the transition to the new classification system by implementing new diagnosis codes, hospital inpatient procedure codes and revision of existing code titles.  Read More »

New CMS initiative to improve care for nursing home residents

The Centers for Medicare & Medicaid Services (CMS) will test a new payment model for nursing facilities and practitioners to further reduce avoidable hospitalizations and lower Medicare and Medicaid spending while improving patient care. Read More »

Medicare unveils Diabetes Prevention Program

Older Americans with a high risk for developing Type 2 diabetes may receive preventive treatment from an unlikely source: Medicare.  Read More »

Congress, LTC battle high drug prices

As Congress and Medicare battle it out with Big Pharma, drug prices continue to gouge those who can afford it the least. Read More »

CMS mapping tool tracks Medicare disparities

A new interactive mapping tool drills down to the state and county levels and reveals where the delivery of Medicare outcomes are falling short across 18 chronic conditions. Read More »

5 treatments seniors don’t want in later life

Many seniors’ health goals shift over time, and the focus on quality instead of quantity has some seniors and theri providers saying “no” to certain treatments. Read More »

New CMS data set shakes out the RUGs

The data set examines the levels of care performed and resources used in skilled nursing facilities, including how many days are billed as the ultra-expensive “ultra-high rehabilitation.” Read More »

NIC releases first report in new SNF data series

The National Investment Center for Seniors Housing & Care (NIC) says the new quarterly reports will give senior housing investors more current data to help guide investment decisions. Read More »

A closer look at CMS’ efforts to reduce avoidable hospitalizations

Does Centers for Medicare & Medicaid Services recognize industry improvements? Washington policy expert Robert Gatty looks at whether the government's efforts have been effective. Read More »

CMS pushes interoperability for LTC

The new initiative allows states to request the 90 percent enhanced matching funds to connect more Medicaid providers to a state health information exchange. Read More »

LeadingAge report: Options for LTSS financing makeover

Financing for long-term care services and suppports (LTSS) is in big trouble and needs new financing options that don't push all the burden onto Medicaid.  A new report from LeadignAge explores some alternatives. Read More »

CMS adds patient experience ratings for home healthcare

The Centers for Medicare and Medicaid Services adds patient experience ratings to its Home Health Compare five-star quality ranking system. Read More »

ACOs thwarted by lack of interoperability

Accountable Care Organizations have spent the past four years struggling to achieve the goals that set them apart. But ACOs still don't have the one thing needed for success: data interoperability. Read More »

CMS examines racial, ethnic disparities in healthcare

Racial and ethnic minority populations are more likely to be readmitted to the hospital within 30 days for certain chronic conditions. The Centers for Medicare & Medicaid Services is exploring the relationship readmission rates and diversity. Read More »

3-day waiver rule on the way out?

The 3-day hospital stay rule might be waving goodbye, but the American Health Care Association warns the new CMS proposal would put some nursing homes—and their residents—at a disadvantage. Read More »

CMS finalizes Medicaid prescription drug reforms

The Centers for Medicare & Medicaid Services finalized reforms to the rebate and reimbursement systems for Medicaid prescription drugs. Read More »