Baseline proficiency for success with managed care payers
By
Susie Mix
Mar 11, 2024
Setting up a building with proficiencies in working with managed care payers is a key to success at this midpoint of the 2020s. Fifty-one percent of Medicare-eligible Americans are covered by Medicare...
CMS official to providers: Help us capture data to drive Medicare Advantage reforms
By
James M. Berklan
Mar 07, 2024
The increased use of health data and providers’ own voices should be considered among the best tools available for achieving change in a system that increasingly relies on Medicaid Advantage and other...
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...
Fogg clears the air on skilled nursing ‘tailwinds’
By
James M. Berklan
Oct 26, 2023
The headwinds for skilled nursing operators are significantly more numerous than the potential tailwinds, but there are reasons for provider optimism.
Insurgence of leveled contracts
By
Susie Mix
Jul 14, 2023
By now, we’re all pretty familiar with the fact that managed care is altering the post-acute care payor mix with Medicare Advantage plans. This is a byproduct of national policy, intended to offset our...
As Medicare Advantage threats mount, providers seek better partners: 2023 Outlook Survey
By
Kimberly Marselas
Jan 06, 2023
More skilled nursing providers are embracing Institutional Special Needs Plans by joining existing programs or creating their own as enrollment in other Medicare Advantage plans surpass half of all Medicare...
‘Strap on your seat belts,’ as post-acute experts forecast opportunities amid threats of week-old...
By
Kimberly Marselas
Jan 27, 2021
Long-term care providers wary of extra scrutiny should also be prepared for new opportunities in an administration that will likely expand insurance coverage and embrace innovative care models that could...
Justice Department investigating Humana billing practices
By
John Hall
Feb 24, 2015
Humana Inc. reports that it is cooperating with a Department of Justice inquiry into whether it exaggerated the severity of elderly patients’ illnesses to generate higher Medicare reimbursements.