Scrooged again: MA plans can’t escape criticism of clandestine coverage rules
By
Kimberly Marselas
Jan 02, 2024
If you were looking for someone deserving to be cast as Ebeneezer Scrooge this holiday season, Medicare Advantage insurers may have just locked up the audition (for this year and maybe future years too).
2024 eagerly awaits you, long-term care faithful
By
James M. Berklan
Dec 21, 2023
As a new year looms, we’re reminded of a pattern that becomes pretty familiar in long-term care if you’ve already seen enough calendar pages disappear.
Prior authorizations 2.0 : A pilot study
By
Steve Shain
Dec 19, 2023
There is one thing more frustrating than a delayed flight: an on-time flight, with a delay mid-air. The pilot announces some airline jargon about a gate change and holding pattern, and next thing you know...
An insider’s guide to managed care contract exclusions
By
Susie Mix
Dec 18, 2023
There’s a key question more providers need to know the answer to: What is a contract exclusion? A contract exclusion details the medications and treatments that are not included in the levels of a managed...
A bum rap?
By
John O'Connor
Dec 18, 2023
I’ve written on topics ranging far and wide across the long-term care spectrum. But I’m pretty sure this will be my first foray into the world of fake butt accusations.
This year they’ll give you something to cry about
By
Kimberly Marselas
Dec 13, 2023
The holidays are here, and that means it’s time for the second-best advertising season of the year. Yes, I know it’s all consumerism designed to make me spend my hard-earned money, but I can’t help...
Medicare Advantage: A not-so-advantageous deal for beneficiaries and providers
By
Brendan Williams
Nov 29, 2023
Open enrollment is well underway for Medicare, as television viewers inundated with cheesy insurance company ads can tell. Those ads must work. For the first time 2024 will see most Medicare...
The MDS on Christmas vacation: ‘It’s a beaut Clark, it’s a beaut!’
By
Joel VanEaton
Nov 28, 2023
I love this time of year. Christmas is on its way. I especially love the holiday movie classics, “A Christmas Story,” “Planes, Trains and Automobiles,” “Miracle on 34th Street,” “White Christmas,”...
Brave new birthday world
By
Gary Tetz
Nov 16, 2023
What do birthdays have to do with long-term care? Well, I’ve been having them long-term. And at this point, I’ve ceased to care. You probably see that statement for what it is, nothing but bitter bluster....
As values shift, it’s time to add something back to nursing
By
Kimberly Marselas
Oct 24, 2023
It seems like everything these days requires a value proposition to be appealing. What can we add to an experience or a product to make it better and one-up the competition?