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...
Physical therapy group opposes proposed 3.6% reimbursement cut
By
Kristen Fischer
Sep 14, 2023
The Alliance for Physical Therapy Quality and Innovation (APTQI) called on the Centers for Medicare & Medicaid Services to revisit its Medicare doctor fee proposal for next year, saying the changes could...
Accelerating the shift to value-based care in LTC settings
By
Jason Feuerman
Jun 07, 2023
Long-term care providers have always played a crucial role in ensuring the health and well-being of the frail and elderly. As practitioners continue grappling with the demands of patient care and running...
Medicaid daily revenue hits record as skilled nursing occupancy dispute flares
By
James M. Berklan
Apr 03, 2023
Medicaid revenue per patient day in skilled nursing facilities rose to a record level in January, even as similar measures for Medicare retreated.
Lawmakers seek to bolster Medicare, Medicaid mental health coverage
By
Alicia Lasek
Dec 07, 2022
Senators cited constituent concerns about so-called ghost networks — listings of physicians who are unavailable to provide care.
Skilled nursing hits pandemic occupancy high but stakeholders still must change, consultant asserts
By
Joe Bush
Nov 08, 2022
Nursing home occupancy continues to rise but rates are still below pre-pandemic levels, indicating it’s time for stakeholders to acknowledge there’s been irreversible change and time to diversify,...
One quarter of SNFs stuck with Medicare margins below 4%
By
Danielle Brown
Jul 21, 2022
Medicare margins for all freestanding skilled nursing facilities across the United States varied widely in 2020, according to new data from the Medicare Payment Advisory Commission.
Nursing home residents targeted in $86M Medicare lab fraud scheme: DOJ
By
Danielle Brown
Jul 09, 2021
Nursing homes and their residents were targeted in an alleged $86 million Medicare fraud scheme orchestrated by the owner of a Tennessee-based lab, federal authorities say.
Managed Medicare revenue, occupancy hit new lows: NIC
By
Danielle Brown
Apr 09, 2021
Managed Medicare revenue per patient day hit a new low in January, despite increasing steadily during the early pandemic months, according to new figures from the National Investment Center for Seniors...