Providers grateful for certain opportunities in proposed 2025 Medicare pay rule
By
James M. Berklan
Apr 02, 2024
Even though debate will continue about how much Medicare reimbursement should rise next year, there’s little disagreement that the Centers for Medicare & Medicaid Services got at least a few things right...
CMS proposes appeals process for Medicare patients placed on observation stay
By
Josh Henreckson
Jan 02, 2024
Medicare patients initially admitted to hospitals as inpatients but later reclassified as outpatients under observation would finally have a process to appeal those decisions, thanks to a long-awaited...
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...
In the quest for Medicare patients, Yelp stars outshine Care Compare
By
Jessica R. Towhey
Sep 22, 2023
More consumers are turning to social media review platforms to help choose a nursing home for family members, but the reviews can be skewed by anecdotal and personal evidence, a new study shows.
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...
Eli Lilly expects Medicare about-face on Alzheimer’s drugs coverage
By
Alicia Lasek
Apr 23, 2023
New data on Lilly’s experimental drug donanemab may influence CMS’s restrictive stance on coverage of this and other amyloid-busting Alzheimer’s treatments, a company executive says.
Senior care scores some wins in congressional budget deal
By
Alicia Lasek
Dec 21, 2022
A Congressional spending package for fiscal year 2023 supports key healthcare policy requests important to long-term care industry stakeholders, saving some clinicians and services from feared cuts.
Medicare Advantage enrollees get less post-acute care than traditional beneficiaries: analysis
By
Joe Bush
Sep 19, 2022
Members of Medicare Advantage plans used post-acute care less than people with traditional Medicare, according to an analysis of 62 studies.