Proposed bill would help ensure home health agencies are reimbursed by Medicare

Two senators have introduced a bill that would reduce the number of inappropriate Medicare denials for home health agencies. Read More »

Turn your data into dollars. Why quality is the new currency.

Performance-based reimbursement requires an efficient approach to documentation and data collection. Between readmission penalties and the IMPACT Act of 2014, the data we use to demonstrate quality outcomes is quickly becoming the currency of our business. Success in the changing reimbursement models means we need to take a data-driven, proactive approach to improving care and quality of life in nursing homes.The Affordable Care Act of 2010 resulted in a provision to develop standards we now know as “QAPI” programs or Quality Assurance & Performance Improvement programs.QAPI is the foundation.Click here to read more. Read More »

BREAKING NEWS: SCOTUS votes to uphold subsidies in King v Burwell

The U.S. Supreme Court voted 6-3 today to uphold marketplace subsidies in the landmark case King v Burwell. Read More »

MatrixCare add EHR interfaces for therapy data

Therapy services documentation and billing just got easier as a leading electronic health record vendor adds interfaces for therapy data. Read More »

Getting ready for assessment data and the IMPACT Act

Workgroups responsible for implementing the standardization of documentation codes across care settings under the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) have been busy during the past year, and SNFs may have to be ready to report under the new assessment data as early as fall 2016, noted panel presenters at this week's Long-Term and Post-Acute Care Health IT Summit in Baltimore. Read More »

Feds arrest several doctors, nurses in largest Medicare fraud bust ever

More than 240 people were arrested in 17 cities for allegedly billing Medicare for $712 million for care that was never given.  Read More »

Caremerge launches chronic care coordination solution

Bridging the gap between physicians, residents and families, Caremerge launches a chronic care management solution that takes care coordination reimbursement into account. Read More »

Miami SNF settles $17M fraudulent referrals case

Hebrew Homes Health Network was accused of improperly paying physicians for referrals of Medicare patients that need skilled nursing care. Read More »

New Payroll Based Journal (PBJ) Reporting Guidelines

The Centers for Medicare and Medicaid Services (CMS) recently issued various documents related to the electronic submission of staffing and census information in an effort to promote greater accountability for long-term care facilities. Referred to as “Payroll Data Submission – Payroll Based Journal (PBJ) Reporting,” this new reporting structure will be mandatory effective July 1, 2016.Read on to learn about the goals of PBJ, what these additional requirements mean to providers, how to approach and implement the changes, and how to address the challenges that must be considered.Click here to read more Read More »

GAO suggests ways to fight Medicaid fraud, improve Medicare audits

CMS plans to issue guidance for screening deceased Medicaid beneficiaries, provide more-complete data for screening Medicaid providers and consider whether the performance of Medicare administrative contractors can be improved. Read More »

Organizations respond to proposed Medicaid changes

Leaders from organizations representing providers of housing, care and services for older adults say they continue to scrutinize the 653-page proposal of reforms to Medicaid managed care plans that the Centers for Medicare & Medicaid Services issued May 26, but they shared their initial reactions with Long-Term Living. Read More »

Getting Ready for the New MDS Focused Survey

In preparation for the shift to value-based reimbursement, Centers for Medicare and Medicaid Services (CMS) has indicated that the new Minimum Data Set (MDS) Focused Survey will be expanding nationwide this year in effort to incent providers to focus more on individualized care planning and person-centered care.Read on to learn what areas will be under the most scrutiny in the new survey process, what you can do to prepare, and some target areas for deficiencies.Click here to read more Read More »

Larry Minnix reflects on his seriously fun time as LeadingAge chief

Looming federal elections present the perfect time to step aside and let a successor fill his shoes, LeadingAge President and CEO Larry Minnix tells Long-Term Living in an exclusive interview. Read More »

NOTICE Act introduced in Senate

Following passage in the House, legislation introduced in the Senate would require hospitals to notify Medicare beneficiaries of their outpatient status within 36 hours after the time of their classification or, if sooner, upon discharge. Read More »

AHCA begins next phase of quality campaign

The American Health Care Association is expanding quality improvement efforts related to its skilled nursing facility members, which it began three years ago, the organization announced May 7. Read More »

Automated data capture sends accounts payable to the cloud

A provider-vendor partnership allows a growing LTC provider chain to move its accounts payable into the cloud. Read More »

Managing in a Managed Care World: Are you Maximizing Your Efficiency and Reimbursement?

The thought of managed care worries many providers. We face uncertainty in how we’ll be paid, and feel anxious we’re not managing operations well enough to capture all of the revenue for the care we’re providing.  In this piece, we’ll explore the basics that will ensure you’ve built the right foundation to survive managed care, while positioning your organization as a preferred provider.Read on to learn how to maximize your efficiency and reimbursement in managed care.Click here to read more. Read More »

MDS items set to expand

CMS intends to implement new or revised MDS coding by October 2016 in its move toward creating a value-based Medicare payment system. Read More »

If Walker becomes president?

Do the actions of a state governor foreshadow the approach he would take and the policies he would advocate if elected to this country’s highest office? If so, then those in long-term care may want to pay attention to what’s going on in the Badger State. Read More »

Trade bill would affect Medicare, groups complain

Four large healthcare trade organizations have sent letters to the Senate and House expressing concerns over a plan to use healthcare dollars to fund provisions in trade bills, resulting in cuts to Medicare. Read More »

HCR ManorCare accused of fraud but disputes claims

The federal government says that HCR ManorCare routinely submitted false claims for rehabilitation therapy services that were not medically reasonable and necessary, but ManorCare asserts that the lawsuit boils down to a “billing dispute.” Read More »

CMS proposes SNF changes

Payments to skilled nursing facilities, quality reporting, value-based purchasing and staffing data collection are addressed in a proposed rule published April 20 in the Federal Register. Read More »

Congress addresses post-acute care payment reform

MedPAC, lawmakers call for payment revisions to cut costs and eliminate abuse in how post-acute care facilities are reimbursed to improve quality of care. Read More »

Quality by the Numbers: Understanding the Five-Star Rating System Changes

Understand what the changes to the Five-Star Rating System mean to your organization.Centers for Medicare and Medicaid has changed the way it calculates the Five-Star Rating System for all facilities serving Medicare and Medicaid residents across the US.  Two new Quality Measures were added for psychotropic treatment, the thresholds for Quality Measure scoring were changed to raise performance expectations, and the staffing algorithm was adjusted to award four stars only to those who achieved a score of four in either or both of the RN and Overall Staffing measures.Read this article to gain perspective on the specific changes that have been made to the rating scale, the effect it is having on the long-term care industry, how it is impacting payment models, and how to address referral partners about the change.Click here to read more. Read More »

Senate passes SGR repeal

The U.S. Senate voted last night to repeal permanently the sustainable growth rate formula under which physicians are reimbursed for care they provide through Medicare. Several organizations representing aging services providers share their perspectives. Read More »

GAO report suggests Medicare, Medicaid improvements

Medicare postpayment claims reviews and state Medicaid sources of funds are two of 24 areas where fragmentation, overlap or duplication exists in the federal government, according to a new report from the Government Accountability Office. Read More »

Seniors concerned about Medicare cost increases, service cuts

Providers and the professional associations advocating on their behalf may be focused on the sustainable growth rate and related issues, but a new survey finds that Medicare beneficiaries are more concerned about potential cost increases and service cuts. Read More »

CMS develops staffing, census system

The Centers for Medicare & Medicaid Services has developed an electronic system whereby long-term care facilities will submit staffing and census information as required under the Affordable Care Act. Read More »

OIG identifies areas for cost, quality improvement

A recent report from the U.S. Department of Health and Human Services Office of Inspector General identifies more than 25 ways that government agencies and programs could save money or improve quality. Read More »

Medicare Advantage to receive 1.25% pay bump in 2016

The 2016 rates for Medicare Advantage plans won't be a dismal as predicted, according to final rate adjustments released today by the Centers for Medicare & Medicaid Services. Read More »