Amid plans to launch the largest provider-owned institutional special needs plan (I-SNP) in the U.S., Brickyard Healthcare is also making sure it surpasses certain other challenges facing the sector. Along with this endeavor, eliminating agency use, preparing for managed Medicaid in Indiana, and being ready to face the staffing mandate, have all been top of […]
Over 50 lawmakers from both chambers of Congress are urging the Centers for Medicare and Medicaid Services (CMS) to increase scrutiny and regulation of artificial intelligence tools used by Medicare Advantage plans. In a letter addressed to CMS Administrator Chiquita Brooks-LaSure, the legislators expressed deep concerns over the use of AI algorithms by MA plans […]
Medicare Fee-for-Service, or traditional Medicare, admissions to nursing homes decreased significantly year over year by almost 20% in the fourth quarter of 2023. Coupled with this drop is a steady rise in Medicare Advantage enrollment, with such plans representing 54.7% of all beneficiaries enrolled in both Medicare Part A and B as of February, Trella […]
Operators have been opting for different payer sources other than Medicare Advantage plans given its persistent challenges. Medicare Advantage’s lower reimbursement rates compared to traditional Medicare and higher administrative burdens tied to prior authorizations and payment denials, have caused operators to seek even Medicaid as an alternative payer, emboldening efforts by advocacy groups to push […]
Expenditures for Nursing facilities and continuing care retirement communities (CCRCs) is expected to reach $237.6 billion in 2026, and $337.4 billion by 2032, according to data released Wednesday. Nursing homes and CCRCs have been increasing steadily since 2021, states a report prepared by the Office of the Actuary (OACT) at the Centers for Medicare & […]
Managed care’s growth across all health care settings, including nursing homes, has pushed reimbursement rates lower, and operators are implementing strategies to counter the situation. For starters, operators expressed the need to be well equipped for negotiating better rates with managed care organizations (MAOs). And, coming armed with cost of care data to the negotiating […]
If there’s no additional funding for the minimum staffing rule, well over 5% of existing facilities will close, depending on how successfully operators can pivot to meet the standard. The rates of closure may even reach 10% to 15%, depending on the market, cautioned sector leaders attending the LTC100 conference this week. Steve Nee, CEO […]
While Medicare Advantage (MA) has grown steadily in the last several years, leaders in the nursing home sector speculate whether increased federal regulation – and perhaps even more importantly, changes in the consumer experience – will slow its growth. This would come as a welcome development to many nursing home leaders, who have been struggling […]
Medicare Advantage plans might lower their payments to nursing homes in 2025, to absorb the federal government’s benchmark rate cut to insurers. Nursing home advocacy groups are worried that this move by the Centers for Medicare & Medicaid Services (CMS) to cut Medicare Advantage rates may be passed on to nursing home providers. The Medicare […]
Nursing homes in Pennsylvania face a critical underfunding of Medicaid, with one in four nursing home beds currently offline due to inadequate reimbursement. Survey findings from LeadingAge PA also point toward the continuing workforce shortage, as to why so many beds are not in use. About 48% of facilities in the state have had to […]
Conspicuously absent data on Medicare Advantage (MA), along with stagnated data collection overall by government agencies, should give nursing home operators cause for concern especially as this trend has influenced company advocacy and negotiating power when it comes to insurance plans. Having this data and understanding how it’s calculated can help operators “speak the same […]
As inadequate funding squeezes nursing homes dry, with Medicare Advantage reimbursing lower than traditional Medicare, and Medicaid funding decades behind on meeting cost of care, facilities are shifting operations to optimize reimbursement. But even that may not be enough. Richard Gamache, CEO of Aldersbridge Communities in Rhode Island, has had to make such operating decisions […]
As Medicare Advantage continues to grow in the skilled nursing space, beneficiaries utilizing traditional Fee-For-Service Medicare have declined, and in turn reimbursement has dropped at an alarming rate. For every two beneficiaries that opted for MA, one FFS individual left the program in 2023, the first year the number of FFS beneficiaries declined in every […]
The growing prevalence of Medicare Advantage (MA) plans in many skilled nursing markets has been a source of mounting challenges for operators, many of whom are wondering whether they can keep up with the change. Yet a few strategies can go a long way to make the transition work, experts said. They cite leveraging data […]
More government scrutiny of Medicare Advantage (MA) plans and data sharing with nursing homes could reduce claims denials and burdens associated with such plans, sector leaders have long argued. And now a report released Thursday by a Congressional advisory body backs that view in shedding light on how enrollees are captured in data. The Medicare […]
Soaring costs associated with skilled nursing – and problematic payer sources – are making it harder for continuing care retirement communities (CCRCs) to provide such labor intensive post-acute care. CCRCs have to ask themselves some hard questions when it comes to what services they can reasonably offer, and if it’s worth it to keep open […]
Sanford Health announced plans Tuesday to break ground on a $200 million project for a continuing care retirement community (CCRC) in South Dakota through its subsidiary, the Evangelical Lutheran Good Samaritan Society. The Good Samaritan Society executives told Skilled Nursing News that the funding for the project is an outcome of a strategy to expand […]
The Centers for Medicare & Medicaid Services (CMS) is placing limits on the use of artificial intelligence (AI) tools in denials of claims related to Medicare Advantage plans, and adding more guidance to health care providers on post-acute care admissions. The agency issued an FAQ Tuesday to address concerns related to coverage criteria and utilization […]
Piece by piece, nursing home operators are seeing stricter government oversight of Medicare Advantage (MA) plans, a welcome relief given that partnerships with such managed care plans have become a huge source of administrative burden for providers in the sector, especially as workforce shortages persist. Most recently, the Centers for Medicare & Medicaid Services (CMS) […]
Nursing home operators can expect to see a lot more regulatory activity in the next few months, with rules and regulations being finalized prior to a potential presidential administration change, with that administration taking office in 2025. A slew of proposed and finalized rules were issued by the Centers for Medicare and Medicaid Services (CMS) […]
