Payment Models

CMS proposes changes to SNF reimbursement

The Centers for Medicare & Medicaid Services is proposing changes to payment rules under the SNF prospective payment system, a wage index update, and a Change in Therapy assessment policy update. June 30 is the last day to comment. Read More »

One MDS assessment may take a NAC more than five hours to complete: study

Where does the time go in a NAC’s day? Results from an American Association of Nurse Assessment Coordination study answer that question. Read More »

Killing the SGR and therapy caps

Congress may be ready to do away with the sustainable growth rate (SGR), re-fix the “doc fix” and ditch therapy caps, but will skilled nursing become the scapegoat for the costs? Read More »

OIG releases strategic plan for 2014-2018

The Department of Health and Human Services and its oversight body, the Office of Inspector General, released reports this week identifying strategic goals for the next few years. Read More »

3-day hospital stay alternatives include new eligibility criteria, payment models

Improved policies and payment models could see more individuals being treated in skilled nursing and rehabilitation facilities as the country looks for ways to reduce costs and unnecessary hospitalizations, one expert believes. Read More »

Research seeks ways to improve long-term care offerings in reformed healthcare system

An academic powerhouse and several senior living service providers are joining forces to try to find ways to increase the quality of long-term care while decreasing unnecessary healthcare spending. Read More »

Research reveals what makes SNF residents, families happy

New research reveals how nursing homes can improve their scores on satisfaction surveys of residents and families. The findings could take on added significance as the Centers for Medicare and Medicaid Services considers moves that could affect the way SNFs are reimbursed. Read More »

Medicare spending varies geographically due to post-acute care differences: IOM

Differences in the use of care at SNFs, rehab facilities and other post-acute settings largely account for variation in Medicare spending across geographic areas, according to a new report. Read More »

CMS’ plans to reform payment to post-acute healthcare cause concern

CMS’ plans for payment reform designed  to cut costs in the post-acute sector for the FY2014 budget may be a cause of concern for the long-term care industry. Read More »

2% Medicare payment reductions begin today

The waiting is over. No resolution to the budget crisis means that sequestration begins—today. Long-term care facilities will feel the effects upfront, but a quieter casuality might be healthcare's information technology and data-sharing initiatives. Read More »

White House, Congress might consider combining Medicare Parts A and B

Sweeping changes may be on the horizon for the way Medicare billing is divided, as President Obama and Republicans put the idea of combining Medicare Parts A and B back on the discussion table, the New York Times reports today. Read More »

MedPAC to Congress: Reduce SNF payments by 4% in 2014

Skilled nursing facilities and home health agencies face payment reductions, but hospices and long-term care hospitals get a first-round bye in MedPAC's latest Medicare payment recommendations to Congress. Read More »

CMS mandates greater disclosure on provider/manufacturer relationships

How much do you know about your GPO? CMS has instituted stricter disclosure rules pertaining to the financial relationships between providers and drug and device manufacturers. Read More »

CMS announces test sites for bundled payment program

Hundreds of provider sites are ready to test the Centers for Medicare & Medicaid Services’ four new models for restructuring the way episodes of care are paid for. Read More »

Washington budget fight has LTC industry fretting over more cuts

The fiscal cliff battle is behind us, but the nation is heading to another possible financial crisis caused largely by politics, and the nursing home sector—and their residents—could well be caught in the middle. Read More »

MedPAC to Congress: Renew Medicare’s special needs plans for long-term care

MedPAC recommends that Congress vote to keep the special needs plans under Medicare Advantage, although some of the plans perform better than others. Read More »

Are SNFs causing their own headaches?

MedPAC proposes more cuts for 2014, and the skilled nursing industry objects. But the GAO issues a report that can only make the industry’s case more difficult. Read More »

AHCA: Medicaid payment shortfalls projected at $7 billion for 2012

A new report released today by the American Health Care Association shows historic shortfalls in what Medicaid pays and what skilled nursing care actually costs. Read More »

HHS says no to full funding for partial Medicaid expansions

The Department of Health & Human Services clarified its position Monday on funding ratios for state Medicaid expansions and published an extensive FAQ list on state health insurance exchanges. Read More »

DOJ orders repayment of improper Medicare reimbursements

In the wake of federal reports of rampant fraudulence Medicare billing, the letters begin arriving at hospitals and other healthcare sites: Medicare wants its money back. Read More »

BREAKING: HHS releases proposed rules for state insurance premiums, workplace wellness programs

The release of today's proposed rules brings the Department of Health & Human Services a few steps closer in building the rules for state health exchanges (HIX). Read More »

Top 10 nursing home deficiencies, top 10 trouble states

The latest version of the Nursing Home Inspect tool includes more ways to search nursing home survey data and to assess the historial track record of a skilled nursing facility. Read More »

BREAKING: Health exchanges: Holdout states get last-minute reprieve

Today was to be decision day for states on whether they intend to participate in the new state health exchange program, but an eleventh-hour extension from Health and Human Services Secretary Sebelius gives the remaining eight states another few weeks to decide. Read More »

SNFs erred on 25% of claims in 2009; $1.5 billion in overpayments

The Office of Inspector General continues to unearth massive misreporting and over-billing in nursing home claims, especially where therapy is involved. Read More »

Brookdale mulls restructuring options amid Medicare reductions

Brookdale Senior Living is considering several financial options to refit its operations in an era of Medicare reductions, announced Brookdale's CFO and co-president Mark Ohlendorf today at the Stephens Fall Investment Conference. Read More »

HHS submits rules for state insurance exchange benefits

The Department of Health and Human Services has submitted another rulemaking piece on state health insurance exchanges to the Office of Management and Budget—the last step before publication. Read More »

AHCA launches Ad firestorm at Congress: No Medicare/Medicaid cuts

Long-term care organizations are using an aggressive advertising campaign to tell Congress to end the deep cuts to Medicare and Medicaid reimbursements. Read More »

Providers get $8.36 billion in Meaningful Use payouts for EHR goals

Under the Centers for Medicare & Medicaid Meaningful Use incentive program for the use of electronic health records, eligible providers have received more than $8 billion in incentive payouts since the program began in early 2011, according to this week's report. Read More »

CMS: Waiver status issued for New York state in Sandy’s wake

An emergency response meeting held by the Centers for Medicare & Medicaid Services answers some questions on coping with the aftermath of Hurricane Sandy in New York, but many issues remain for long-term and acute care facilities in other states. Read More »

LTC transitions of care: Get collaborative or play catch-up, says national TOC group

Are transitions of care on your mind? You’re not alone. Read our on-site coverage of the National Transitions of Care Coalition (NTOCC) Midwest Regional Summit, held this month in Cleveland, for tips and free tools to improve your TOC efforts. Read More »