On the Move: Consulate appoints new COO … Former CMS head says MA plans are gaming the system … Too many skilled nursing websites show performance, access problems, audit warns … Legionaire’s case...
Jimmo correction: Assistants may provide maintenance services in skilled nursing facilities
By
Tim Mullaney
Jan 17, 2014
Skilled nursing facilities may be reimbursed for maintenance therapy services performed by assistants, the Centers for Medicare & Medicaid Services clarified in a recent Medicare Benefit Policy manual...
CMS completes minimum staffing study; targeting ‘onerous’ MA authorizations
By
Kimberly Marselas
Jan 25, 2023
Two proposed rules should help patients improve their Medicare Advantage plan selections while standardizing expectations for skilled nursing and other healthcare providers, federal officials reiterated...
‘Death spiral’ for SNFs as Medicare Advantage pay decreases
By
Kimberly Marselas
Sep 06, 2022
Pressure to accept low-ball contracts with Medicare Advantage plans that continue to reduce reimbursement is driving some skilled nursing providers into “a death spiral,” a major aging services association...
‘Impossible’ Medicare Advantage denials decried during Senate hearing
By
Kimberly Marselas
May 18, 2023
A Senate subcommittee Wednesday sent letters to the nation’s largest Medicare Advantage insurers, demanding they reveal internal documents that illustrate how they make coverage determinations.
Analysts break ground with first batch of SNF Medicare Advantage data
By
James M. Berklan
Oct 11, 2021
Managed care plans typically hold all the cards when it comes to rate-setting. But a new way of analyzing billing data could finally give increasingly leveraged providers a better leg to stand on, financial...
MA plans pocket billions more by enrolling less-costly patients
By
Kimberly Marselas
Jun 16, 2023
Medicare Advantage plans may be receiving overpayments of as much as 20%, finds a new study published by a health and aging think tank.
Low-quality Medicare Advantage plans should expect scrutiny, CMS says
By
McKnight's Staff
Apr 13, 2012
Medicare Advantage plans with fewer than five stars on the quality scale should expect some form of audit, a Centers for Medicare & Medicaid official said this week.
The ACA’s ‘comprehensive’ long-term care failure
By
Tim Mullaney
Nov 19, 2013
There’s been a lot of talk lately about what constitutes “comprehensive” health insurance coverage — and long-term care notably has not been part of this national conversation.
CMS issues notice of sanctions to Medicare Advantage insurer
May 19, 2010
The Centers for Medicare & Medicaid Services this week informed Medicare Advantage insurer Quality Health Plans of its intent to impose intermediate sanctions and a civil monetary penalty (CMP) on the...