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...
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...
Ready, set, review!
By
Renee Kinder
May 11, 2023
We’ve all been waiting for this. We knew it was coming! What am I speaking of? The May 4, 2023, notice of Skilled Nursing Facility (SNF) 5-Claim Probe and Educate Review, of course! Since the initiation...
Loophole allows low volume Medicare providers exemption from auditing
By
Kristin Walter
Dec 15, 2017
The current implementation of Medicare’s sliding scale ADR limit policy is preventing the recovery of improper payments and has afforded a significant portion of providers with immunity from billing...
The Jimmo scorecard and CMS compliance update
By
Steven Littlehale
Nov 25, 2014
In some ways, 2014 has been a monumental year. But it’s not over yet, especially with regard to Centers for Medicare & Medicaid Services steps regarding the historic Jimmo settlement agreement signed...
Campaign 2012 boosted importance, value of nursing home care in public policy dialogue
By
Alan G. Rosenbloom
Nov 12, 2012
Despite the customary complaints about negativity and the avalanche of TV ads, the 2012 campaign was unusually substantive from the standpoint of the entitlement reform discussion because both sides were...
Stop the ‘siloed’ policy making for skilled nursing
By
Alan G. Rosenbloom
Mar 21, 2012
Last week, three reports issued by three separate government agencies made incongruent recommendations — or no recommendations at all — related to skilled nursing facility (SNF) patient care and policy....
How to make your nursing facility RAC-ready
By
Bryan Baird
Nov 08, 2011
As skilled nursing facilities adjust to the changes to Medicare that arrived early last month, they must be ready for Recovery Audit Contractors. RACs are independent auditors for the government that are...
The growing cost of compliance in long-term care
By
Michael K. Loucks
Nov 09, 2010
The Patient Protection and Affordable Care Act will expand compliance-related regulations for skilled nursing facilities.
What the long-term care world needs now
By
Dave Sedgwick
Apr 27, 2010
The time has come to decentralize long-term care organizations to attract more entrepreneurial, innovative and committed leaders.