Payment Models

Need technology? Take the trauma out of your IT initiatives

Technology projects planned with the input of all departments have the best staff buy-in and training engagement, says a panel of long-term care project managers who have tackled the IT challenges in their own organizations. Avoid “tech trauma” by learning their tips on IT project strategy.

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LTC trends report: Reimbursement #1 challenge, technology #1 game changer

Amid the cuts in payments and struggles with occupancy rates, the current long-term care business environment has opportunities for innovation in cost models, care delivery models and technology-driven value, notes the 28th annual Licensed Nursing Facility Cost Comparison.

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How well can we control healthcare-associated infections (HAIs)?

Several recent studies show varying levels of success for infection-reduction programs, including efforts to curb MRSA, CLABSI and CAUTI rates. But the jury is still out on whether healthcare-associated infection (HAI) programs are making progress because of Medicare's new policies—or in spite of them.

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“Frequent users” are not abusing ER services, multi-state studies say

Seniors have been accused of overusing the Emergency Room, often as a substitute primary care provider. But new studies from a national emergency medicine association say that their ER visits are usually justified.

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AHCA/NCAL: Future of LTC relies on leadership and resilience

A few raindrops didn't dampen the spirits of more than 2,000 attendees and 350+ vendors who celebrated the resilience and discussed the challenges of long-term care on today's opening day of the AHCA/NCAL Conference and Expo in Tampa, Fla.

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DOJ & HHS charge 91 people with $430 million in Medicare fraud

A federal strike force from the Department of health & Human Services and the U.S. Atorney General’s office have charged almost 100 people with a total of $430 million in fraudulent Medicare billing practices.

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Turning a blind eye to the rules

Sharon A. Nazarchuk and Timothy Legg studied a pool of skilled nursing facilities to uncover discrepancies in survey data, including why skilled nursing facilities can fail to employ qualified activity directors yet still escape citations during the survey process.

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Hospital readmission penalties off to a rocky start

CMS’ new program to make hospitals financially accountable for excessive readmissions stumbles at the starting gate, as CMS issues a document to correct errors in the final rule. Read More »

Report compares healthcare plans under Obama, Romney

As the presidential debates begin this week, Medicare is predicted to be a hot-button topic. One private foundation released a report that explores the differences and similarities between the healthcare plans of both presidential candidates. Read More »

Largest ACO model project sees significant savings among dual-eligibles

Five years of data from Center for Medicare & Medicaid’s largest experiment in performance-based reimbursement are mixed, but physician groups succeeded in slashing the costs for dual-eligibles. Read More »

AHCA to CMS: Change rule on observation stays, Medicare A-to-B billing

The Centers for Medicare & Medicaid Services' rule on hospital "observation stays" has generated much controversy. The American Health Care Association strikes back with a long list of changes that should be made--and why. Read More »

Nursing home cutbacks could tally $65 billion over next decade

The unfortunate overlap of multiple payment-reduction laws and regulations could add up to $65 billion less for skilled nursing home budgets over the next 10 years, according to nationwide data released today. Read More »

CMS set to begin hospital RAC audits in 11 states

The Centers for Medicare & Medicaid Services is finally set to begin a three-year project to reduce fraud and errors by using RACs to check Medicare claims before they move to the payment stage. Read More »

SNFs to get 1.8 percent increase in payment rates

CMS will increase prospective payment system pay rates to skilled nursing facilities by almost 2 percent, based on its yearly rate adjustment report. Read More »

CMS adds another $275 million in funding for state system improvements

CMS offers $275 million to 25 more states the funding to design and build new payment models that bring multiple payers together and improve the care delivery system. Read More »

New tool assesses financial impact of ICD-10 switch

The Health Information Management Systems Society (HIMSS) and technology company Jvion have developed an online tool to help facilities calculate the financial impacts of migrating to ICD-10. Read More »

CMS proposes higher pay rates for end-stage renal disease

The Centers for Medicare & Medicaid Services has proposed policy changes that would increase reimbursement rates for end-stage renal disease services. Performance data collected next year would affect the payment rates starting in 2015. Read More »

Supreme Court upholds Affordable Care Act

BREAKING NEWS: Supreme Court has decided the Affordable Care Act will stay in place. The majority voted to keep individual mandate and the right for Congress to offer funding for state reform programs. Read More »

eHDS User Group: While CMS continues to innovate, unpredictable Congress could cut healthcare funding

NASL’s Cynthia Morton shares insights on Congressional legislation and CMS innovation projects with attendees at this week’s eHDS User Group meeting. Read More »

LTPAC HIT Summit: Leaders reveal goals, concerns for 2012-2014 and meaningful use

Today’s morning sessions at the LTPAC HIT Summit included the “Roadmap for 2012-2014” and the meaningful use keynote by Deputy National Coordinator for Programs and Policy Judy Murphy, RN. Both share how far we’ve come in the last two years, and how much further we need to go. Read More »

Medicare cuts could cost SNFs close to $800 million

Skilled nursing facilities are gearing up to absorb nearly $800 million in Medicare cuts in 2014, according to a new analysis from Avalere Health and the Alliance for Quality Nursing Home Care. Read More »

CMS memo clarifies PPS billing, assessment policies

The memo also introduced a new policy, effective April 1, 2012, for how providers should handle interviews on unscheduled PPS assessments. Read More »

How to maximize reimbursement in turbulent times

Skilled nursing facilities must smartly adapt to monumental changes in order to capture market share, maximize reimbursement based on meeting patient needs and accurately capture all funding. Read More »

Reflections on a life in long-term care

Long-Term Living contributor Eli Pick’s account of a life in long-term care offers valuable insights and lessons learned from failures and successes along the way. "This was very difficult for me in the beginning," he writes. Read More »

The new PPS challenge: Change of Therapy OMRA

Carol Maher, RN-BC, RAC-CT October 2011 came to pass with a whole host of challenges for the SNF Prospective Payment System (PPS). Along with Read More »

Study shows Americans understand need for LTC planning, but slow to take action

Nearly eight in 10 Americans acknowledge the increasing need for long-term care planning, yet almost half are “not sure” how they plan to address Read More »

Feeling the fire of SNF PPS rule

The final SNF PPS rule for FY2012 published in August will cause all operational professionals to stop and think about their implementation plans for Read More »

One year later: Administrators speak out on 3.0

Last August, Long-Term Living gauged the mood and outlook of four administrators as they readied their teams for one of the largest operational Read More »

Does anyone out there care?

Janet Gerber, RN-BC Mathematically, I have always “assumed” that if you were dividing a whole into “quarters” that would mean you would have four Read More »

It’s time for a look-back period

Everyone needs a good sounding board. For many nurses, that forum is oftentimes a listserv. In commemoration of last year's big MDS package, Read More »