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.
CCRCs facing financial threats in their skilled care units, but there are silver linings: experts
By
Josh Henreckson
Feb 16, 2024
Facing the mounting financial challenges of providing skilled care on their campuses, continuing care retirement communities should carefully weigh a variety of tactics and the particularities of local...
Long-term care leaders cheer proposed Medicare Advantage appeals rule in final push
By
Josh Henreckson
Jan 08, 2024
A surge of public and professional support arrived Friday as the comment period closed for a proposed federal rule that providers say could level the playing field with Medicare Advantage plans.
Class action suit targets Medicare Advantage insurer’s use of AI to end rehab stays
By
Josh Henreckson
Dec 14, 2023
Two skilled nursing patients filed a class action suit against Humana Tuesday — alleging their Medicare Advantage benefits were cut prematurely short because of Humana’s wrongful reliance on artificial...
Amid cacophony of action, some happy noise on Medicare Advantage
By
Kimberly Marselas
Nov 08, 2023
CHICAGO — I was drawn into the provider payment conversation early and often at the LeadingAge conference here this week, but the tone wasn’t quite what I expected. After years of dark messaging on...
CMS proposal offers long-awaited fix for Medicare Advantage appeals
By
Kimberly Marselas
Nov 08, 2023
Skilled nursing providers would get a new, improved appeals process for Medicare Advantage denials under a proposal issued late Monday by the Centers for Medicare & Medicaid Services.
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.
Another week, more Medicare dis-Advantages
By
Kimberly Marselas
Aug 22, 2023
It’s starting to feel like every week brings another reason to begrudge Medicare Advantage plans their market-dominating growth.
The threat hiding in plain sight
By
Brendan Williams
Jun 05, 2023
Through overpayments, the federal government has effectively created unbeatable competition to the Medicare Fee For Service model, but at what cost to consumers and providers?
‘Impossible’ Medicare Advantage denials decried during Senate hearing
By
Kimberly Marselas
May 18, 2023
A Senate subcommittee Wednesday sent letters to the nation’s largest Medicare Advantage insurers, demanding they reveal internal documents that illustrate how they make coverage determinations.