Nursing homes have to fight for pay protections in Medicare Advantage rule: expert
By
Kimberly Marselas
Apr 27, 2023
Providers must play an active role in stopping aggressive Medicare Advantage practices that have for years limited access to skilled nursing care, a top managed care expert warned administrators gathered...
When one dangerous compromise leads to another
By
James M. Berklan
Jun 28, 2021
Sometimes providers are backed into a corner and must do non-preferred things. But the big question becomes what’s the next step after the first concession?
I pay dead people
By
Jacqueline Vance, RNC, CDONA/LTC
Nov 12, 2013
On Oct. 31 (an ironic coincidence?) a report from the Office of inspector General frighteningly said Medicare paid some $23 million in benefits for more than 17,000 dead people in 2011. And my husband...
Final rate notice signals continued pressure on Medicare Advantage payments
By
Jennifer Rak
Apr 21, 2014
CMS recently finalized Medicare Advantage plan payment rates for Calendar Year 2015 and announced other changes to payment and program policies for MA and Part D plans. Although the announcement included...
Can Medicare Advantage be redeemed?
By
Jean Wendland Porter
Feb 06, 2024
I just got back from vacation and didn’t have to think about this for a whole week. But there’s no place like home. For a whole week, I didn’t have to worry about chores, obligations, or how Medicare...
Medicare Advantage retaining sicker patients with more complex health needs: study
By
Alicia Lasek
Jun 29, 2023
After years of criticism for cherry-picking healthier people for enrollment, Medicare Advantage is now holding onto more patients with chronic conditions, investigators say.
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...
A Medicare Advantage fix: What took so long?
By
James M. Berklan
Apr 12, 2024
Providers hoping that policy makers might some day show some backbone when dealing with Medicare Advantage plans can take heart. Well, at least a little.
Understanding facility, peer data called crucial to better Medicare Advantage negotiations
By
Josh Henreckson
Mar 27, 2024
Nursing homes have historically had little leverage in negotiations with Medicare Advantage plans, even as MA has come to cover an ever-larger number of skilled nursing beneficiaries.
As Medicare Advantage drives rate lower, fed-up CEOs embrace strategies that limit carriers’ influence
By
Kimberly Marselas
Apr 26, 2021
Medicare Advantage’s aggressive market penetration represents a major threat to skilled nursing providers, some of whom now find themselves clearing less per resident day through MA plans than they do...