CMS let the cat out of the bag, but it’s managed care that’s ready to pounce
By
Kimberly Marselas
May 05, 2021
If you work with managed care (and who doesn’t anymore), chances are pretty good you’re already on a collision course that’s been accelerated lately
Cutting with a plan — it applies to you too
By
Renee Kinder
Aug 16, 2018
With all the buzz, excitement, and, need I say, even moments of panic around the final rule and clarifications for the Patient Driven Payment Model (PDPM), we as an industry need to remain purposeful in...
LTC truths you just can’t ignore
By
James M. Berklan
Nov 07, 2018
I bring you some of the striking tidbits from frantically filed notes on the road that might or might not have already seen the light of day. Some of this is just too good not to share, or share again.
Research those CMS dinner invitations thoroughly
By
James M. Berklan
Aug 13, 2021
I don’t know what was more shocking this week: A warning that federal regulators might actually double the amount they could trim from nursing home reimbursement rates next year or the way some veteran...
The value of therapy in the New World Order of PDPM
By
Jean Wendland Porter
Apr 10, 2019
Rationing care may benefit the facility’s bottom line in the short term, but will not generate positive outcomes and good will in the community. As I advise and sometimes lecture, we need to do the right...
CMS eyeing PDPM case-mix additions, changes
By
Kimberly Marselas
Apr 24, 2023
Federal regulators are weighing changes to the three-year-old Patient Driven Payment Model to account for missed opportunities — and potentially inappropriate coding choices — a top Medicare official...
Medicare Advantage plans forcing providers to take ‘optional’ payment reductions
By
Kimberly Marselas
Nov 15, 2022
Many skilled nursing providers are still underusing Interim Payment Assessments under the nascent Patient Drive Payment Model, but one new pressure is driving some to submit those extra patient evaluations...
The top lessons learned from the AHCA’s 2021 Convention and Expo
By
Tamar Abell
Nov 05, 2021
Attending the American Health Care Association’s (AHCA) 2021 Convention and Expo this year felt like reuniting with friends after spending two years on the frontline of a battlefield. The...
Data expert strips down PDPM myths, truths
By
James M. Berklan
Feb 25, 2019
Long-term care professionals have been diligently cramming to prepare for a new skilled nursing reimbursement system in October, but a data expert had a sobering observation for presentation attendees...
Understanding PDPM in value-based purchasing
By
Joel VanEaton
Jul 15, 2019
CMS has been clear that a major aspect to the design of the PDPM is payment that is quality informed. That cannot be overstated.