Headlines

Cigna is settling a federal claim for knowingly submitting false diagnosis codes to Medicare Advantage plans. Investigators alleged that Cigna submitted inaccurate and untruthful codes from 2016 to 2021, violating the false claims act. In one example, federal prosecutors said Cigna submitted reimbursement documents for patients who are morbidly obese but did not submit medical

Medicare Advantage (MA) plans in rural areas have quadrupled since 2010. In 2023, the average Medicare beneficiary in a rural area has 27 Medicare Advantage plans to choose from, which is why ensuring that your facility is contracted with managed care is so important. View Article Here

Medicare Advantage (MA) enrollment has been trending up the last two decades and most of the enrollees are managed by MCO’s. The Medicare Modernization Act of 2003 created stronger financial incentives for plans to participate in the program throughout the country and renamed private Medicare plans Medicare Advantage. In 2023, more than half (51%) of

Humana will be exiting the Employer Group Commercial Medical Products business, which includes all fully insured, self-funded and Federal Employee Health Benefit medical plans, as well as associated wellness and rewards programs. The exit from this line of business will be phased over the next 18 to 24 months. They plan to focus in the

It looks as though the pandemic will be around for quite some time. Skilled nursing facilities have been forced to rethink how they are providing care. Many are finding they must embrace the change in order to move forward and focus on strategic goals. For more on this, please see the article below.  View Article

A recent analysis found a 14% increase in the number of patients being discharged home from skilled nursing facilities. It’s worth noting that this only equates to around one person per month transitioning to the home. Most often, these were patients who had stayed at the nursing home for at least 100 days. The article below

In order to make more informed decisions and maximize financial gains, providers must embrace data utilization to succeed in the current market. Access Advantage offers back-office support and troubleshooting for payer operations, contracting, renegotiations, and revenue cycle management. We offer a specialized performance profiling report, our Map to Market (M2M). Let us know if your

Medicare Part A covers a skilled nursing facility stay only if the individual was admitted for three days at the hospital as opposed to under observation, which is considered outpatient. This article eloquently explains the difference between being admitted to a hospital versus under observation, what has changed during the pandemic, and what that means

Many SNFs are taking on higher acuity patients and embracing on-site dialysis post-COVID. This article, showcasing an on-site dialysis company, looks into the growing need for this service. View Article Here

Communication, quality metrics and the ability to take on high-acuity patients are a few things that hospitals are most interested in when deciding which skilled nursing facility to discharge patients. For more on what hospitals are looking for, please see the article below. View Article Here

Skilled nursing facilities have seen an increase in occupancy this year, leading many to wonder if this means stabilization post-COVID. Several states have shown an occupancy increase of more than 5%. For more on this, with a look into which states are showing the biggest increase, please see the article below. View Article Here

While SNFs might fear home care as direct competition, some think it should be viewed as a partner in the spectrum of care. With hospitals, skilled facilities and home care all performing in silos, current development in home-based care is highlighting opportunities to improve transitions from one space to the next. For more on this,

Experts believe that skilled nursing facilities may see their occupancy levels reach pre-pandemic levels by the first quarter of 2022. For more on this, please see the article below. View Article Here

The Centers for Medicare and Medicaid Services (CMS) has passed Medicare-certified providers more than $100 billion under the Accelerated and Advance Payments (AAP) program. Under the terms of this program, CMS plans to keep 25% of a given facility’s Medicare payments for the first 11 months of the recoupment period, starting one year from the date

Providers with lower rehospitalization rates are much more appealing to payers. The article below details how therapy intensity may directly lead to better outcomes for nursing home residents and improved ratings. Contact us today to learn more about the contracts you’re interested in! View Article Here

There are many things payers are looking for when requesting a contract, private rooms being of them. This article shows how the pandemic has encouraged skilled nursing facilities to move to private rooms and why it’s imperative to take advantage of the financial support the government is offering to renovate and remain competitive. View Article

According to The National Law Review, “providers who had invested heavily in value-based care have been better able to weather the pandemic and the economic downturn by having a consistent source of revenue despite low utilization”. The article below details the five emerging trends in value-based care to look out for this year. View Article

A recent report showed that the national median occupancy for skilled nursing facilities is around 69% at the start of this year. Access Advantage can help with your out-of-network problems! With our routine meetings with payers and a Four Star network, we are your managed care solution. View Article Here

Many of our Members significantly exceed performance expectations. Regina Health Center, a Five Star skilled nursing and assisted living facility in Richfield, is no exception. Regina has achieved a rating of “High Performing”, being recognized as a Best Nursing Home for 2020-21 by US News & World Report. See the article below for more on

In an attempt to streamline prior authorizations and free up staff time, the Centers for Medicare and Medicaid Services (CMS) have proposed a new rule that would reduce administrative burden for providers. The article below details out the many proposed changes. View Article Here

In November of this year, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to Medicaid managed care regulations that had been proposed two years prior. Changes include updates to network adequacy standards, beneficiary protections, rates and payment. For more on this, see the article below. View Article Here

An increase in capitated rates may prove positive for Medicare Advantage (MA) payers like Humana, UnitedHealthcare, Aetna and Anthem in 2022. To combat improper inflation of risk scores, the Centers for Medicare and Medicaid Services (CMS) is proposing to rely on encounter data to calculate patient risk. For more on this, please see the article

An institutional special needs plan (I-SNP) is essentially where a nursing home becomes a Medicare Advantage (MA) provider. Many who are venturing into this process started last year. COVID-19, however, has delivered major challenges. The article below details clinical upsides being discovered as well as a view of how timetables are currently adjusting. View Article

Under the new Patient-Driven Payment Model (PDPM), Medicare rates are determined by a formula that captures how providers measure on five care components. Those that are performing well under PDPM are effectively capturing key payment drivers and not leaving money on the table. For more on this, please see the article below. View Article Here

Post- pandemic rules for nursing home care may look different than before or even during the crisis. Though some changes made during the health emergency, telemedicine restrictions, for example, being loosened may remain, others like the three-day stay requirement may not. For more on this, please see the article below. View Article Here

Seema Verma, Centers for Medicare & Medicaid Services (CMS) Administrator, recently opened up about nursing home testing for COVID-19, noting testing should be routine. New rules presented last month require facilities to test with a specific frequency depending on the spread in the surrounding county. For frequency specificity and more on this, please see the

With skilled nursing occupancy down-trending since 2015, the pandemic made things much more difficult for facilities. In June this year, however, Managed Medicare increased, resulting in what appear to be stabilizing revenue streams. For more on this, please see the article below. View Article Here

This week the federal government proposed a new metric that would measure and track nursing home stays resulting in infections. For more on this, please see the article below. View Article Here

A recent analysis by experts at Avalere showed that policies currently reshaping Medicare Advantage Star Ratings during the COVID-19 emergency could have long-lasting effects on the Program. For more information, please see the article below. View Article Here

Earlier this year The Centers for Medicare and Medicaid Services (CMS) suspended nursing home inspections to focus attention on the COVID-19 pandemic. On Monday of this week, CMS announced it will resume inspections for all providers that are Medicare and Medicaid certified. For more on this see the article below. View Article Here

The Centers for Medicare & Medicaid Services (CMS) is proposing reductions to Medicare Part B reimbursement for physical therapy (PT) and occupational therapy (OT). For more on this proposed 9% cut, please see the article below. View Article Here

The Centers for Medicare and Medicaid Services (CMS) have announced that nursing homes will receive a $750 million Medicare pay increase in 2021. For more on this and insight into the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) please see below. View Article Here

Between the fourth quarter of 2018 and the fourth quarter of 2019, Medicare Advantage increased to account for 34 percent of Medicare.  It’s predicted that this rise will continue this year. For more on this, please see the article below. View Article Here

CMS Administrator Seema Verma has indicated that telehealth expansions put in place during the pandemic may be permanent after a thorough assessment. For more on this with a look into three areas being examined before permanent telehealth expansions are finalized, please see the article below. View Article Here

Facilities that were acquired early in 2020 have noticed the much needed Medicare relief fund meant to help weather the financial strains of the COVID-19 crisis, stuck in limbo. Funds were distributed to providers based on their 2019 Medicare reimbursements by the Department of Health and Human Services (HHS), who sent money to the account

The Centers for Medicare and Medicaid Services (CMS) unveiled enhancement enforcement actions for nursing homes based on COVID-19 data and inspection results. This announcement came on June 1, 2020, expanding on the previous actions taken by CMS to assure safety and security in nursing homes during the COVID-19 crisis. Facilities with persistent infection control violations

In October of last year, the Patient-Driven Payment Model (PDPM) was implemented, more closely linking Medicare reimbursement with resident acuity. The current COVID-19 crisis appears to have validated the federal government’s decision to replace the RUGs model with PDPM. For more on this see the article below. View Article Here

To protect the progress of the value-based payment reform, the American College of Physicians (ACP) recently reached out to the Centers for Medicare & Medicaid Services (CMS) recommending to extend flexibilities in the Quality Payment Program (QPP) to protect clinicians against long-term effects of the COVID-19 crisis. For visibility to the proposed flexibilities ACP outlined

The Centers for Disease Control and Prevention (CDC) is requiring all nursing homes to report COVID-19 information every seven days. This data will serve to capture the trajectory of the disease and help providers gather the necessary resources.  For more on this please see the article below. View Article Here

Senior living facilities currently show that around 30% of their residents are enrolled in a Medicare Advantage (MA) plan. We’ve been tracking this for years, noting that MA continues to grow across Ohio’s 88 counties. Our most recent MA enrollment report shows that Ohio now exceeds 50% MA penetration in some urban counties and 40%

The Centers for Medicare and Medicaid Services (CMS) has finalized rule changes that encourage Medicare Advantage (MA) plans to increase their telehealth benefits. Now, MA plans will be able to cover a wider range of telehealth specialty providers. CMS is also looking to ease policies for rural healthcare to make MA offerings available to rural

Currently, skilled nursing facilities (SNFs) are facing a very challenging environment. This article presents new and existing opportunities for SNFs to succeed. Plante Moran’s report is referenced, which compares around 15,000 Medicare-certified SNFs to identify their operating, revenue and expense metrics. See below for interesting takeaways. View Article Here

The Centers for Medicare & Medicaid Services (CMS) announced they will be using providers’ staffing totals to identify their personal protective equipment (PPE) needs during the coronavirus pandemic. CMS also plans to freeze nursing home inspections star ratings during the emergency. For more on this, please see the article below. View Article Here

Recently, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule for skilled nursing facility (SNF) payments for the coming year. If finalized, the rule would see nursing homes receive a 2.3% Medicare pay bump, update the SNF prospective payment system (PPS) wage index and update the way IDC-10 codes map under the

Payer COVID-19 policies continue to come in, with anticipated additions over the days and weeks ahead. Payers are relaxing their policies and implementing emergency actions to accommodate the influx of healthcare services needed at this time. Please see below for the latest update(s) since our last alert. Ohio Department of Medicaid (ODM) – In response

In light of the COVID-19 emergency, the Centers for Medicare and Medicaid Services (CMS) has temporarily postponed facility inspections. Focus has instead shifted to infection control and Immediate Jeopardy situations.  For more on this as well as a look at the three-pronged approach to identify which providers, hospitals and labs across the country are prepared

Payer COVID-19 policies continue to come in, with anticipated additions over the days and weeks ahead. Payers are relaxing their policies and implementing emergency actions to accommodate the influx of healthcare services needed at this time. Please see below for the latest update(s) since our last alert. Anthem – Beginning March 26, 2020 Anthem health

Payer COVID-19 policies are beginning to come in, with anticipated additions over the days and weeks ahead. Please note several payers have made changes to their prior authorization (PA) protocols. Aultcare – Recently developed a policy to make it easier to access medical care virtually. The policy, applicable to all medically necessary services, will be

The Centers for Medicare and Medicaid Services (CMS) has issued guidance to Medicare Advantage Plans to address their obligations and flexibilities with regards to the emergency caused by COVID-19. This article includes Medicare Advantage special requirements, permissive actions and an Ohio bulletin notifying companies of their obligation to provide access to the healthcare services to

Late last week The Centers for Medicare and Medicaid Services (CMS) posted information regarding COVID-19 Medicare coverage and payment. This article focuses on coverage for diagnostic tests, vaccines, inpatient hospital care services, quarantines and much more. Please see below post. View Article Here

A study by Leading Age recently showed that over 500 nursing homes in the US have closed in the past four years. These closures caused by several factors including, but not limited to, rising costs, pressures from payers and increased competition. This article highlights changes the industry is facing, as well as how managed care

The Centers of Medicare and Medicaid Services (CMS) has proposed changes to standards and operations for Medicare Advantage in 2021.  Please see the article below for more on what to expect. View Article Here

The CMS will be looking to “Free physicians to spend time caring for their patients,” this year according to CMS Administrator Seema Verma. After analyzing thousands of comments received and hosting multiple listening sessions, CMS is looking into solutions this year to improve the prior authorization process. For more on this, see the article below.

A look at five changes payers and providers can expect, this article details why the said changes are happening and how to prepare for each. View Article Here

This sounds a lot like what we’ve been doing since Day 1. View Article Here

In the first few months of the Patient Driven Payment Model (PDPM), there have proven to be a few rather successful strategies. Two of the most impactful things that Skilled Nursing Facilities (SNFs) are focusing on are data and clear communication of their high acuity to hospitals. For more on this please see the article

An interesting look back at 2019 and a few of the more interesting moments that were more or less overshadowed by the shift to PDPM. From an account of the impact ACO’s have had on SNF’s, to a piece on one state’s attempt to remove long-term residents from managed Medicaid, this article touches on some

This article is a great example of a skilled nursing facility (SNF) using CMS data to react and respond to issues affecting their quality of care. Showcased, a facility that was able to reduce short-term stays for Medicare by 45% and able to rehabilitate patients more efficiently than surrounding SNFs. For more on this, please

Now that 2020 has arrived, an overwhelming number of Americans will be reaching the age where high levels of personal care are needed. Studies have shown that around the age of 80, individuals become notably frailer and health-related issues skyrocket. The Forbes article below notes that over 77 million Americans will reach the age of

Too many readmissions within 30 days will cause CMS to penalize over 2,500 hospitals in 2020 according to a Kaiser Health News report. These penalties are estimated to cost hospitals over $563 million over the year. Kaiser’s report notes that 83% of the 3,129 hospitals evaluated in the Hospital Readmission Reduction Program received a penalty,

Last week, the American Health Care Association and National Center for Assisted Living hosted the first Population Health Management Summit which focused primarily on how the healthcare landscape is shifting from volume to value. Medicare Advantage plans, positioned to drive payment and delivery reform, are expected to become the dominant form of Medicare by the

Three health networks in Boston formed an accountable care organization (ACO) this year, the Beth Israel Lahey Performance Network (BILPN). This ACO sees an opportunity in sending patients directly to a skilled nursing facility (SNF) without requiring a three-day hospital stay. BILPN’s three-day waiver program is meant to provide a path for patients who don’t

Hospitals will have until 2021 to comply with the rule to publish payer-negotiated prices. This rule, requiring hospitals to post rates in a more convenient format, was originally slated to begin in 2020. For more on this, see the article below. View Article Here

According to the 2019 Industry Trend Report from Trella Health, skilled nursing facility (SNF) admissions are dropping across the country while home health agencies have become the most likely post-acute referral destination. Some states have seen a decline in SNF admissions anywhere between 14% and 26%. For more on this, see the article below. View

Managed Care continues to grow! This decade, there has been a 10% increase in Medicare Advantage enrollment for all eligible beneficiaries. For more on this and how the majority of seniors are more than satisfied with Managed Care, see the article below. View Article Here

Hospitals are demanding national standards for prior authorizations regardless of which Payer they are working with. Hospitals often believe they have followed the required steps and process flawlessly, only to discover their claim was denied. This inevitably leads to a painful and lengthy appeals process. This article addresses the pain points many providers are feeling

CMS has finalized a new rule requiring hospitals to give patients better visibility to their post-acute provider choices. This rule will not impact the anti-steering regulations that prevent hospitals from recommending specific skilled nursing facilities, but rather enlighten the patient to make a more informed decision to their post-acute care while also considering their goals

With mergers-and-acquisitions becoming more prevalent in the skilled nursing space, many operators are experiencing issues with negative press, difficulties obtaining bank loans, and even Star rating impacts bubbling up from the previous owners. For more on this, please see the article below. View Article Here

With Medicaid reimbursement cuts coming to Michigan, it’s more important than ever to grow your arsenal of Managed Care contracts. Let us know if we can help! View Article Here

Cyberattack prevention is more important than ever. The overwhelming majority of ransomware attacks are targeted towards small businesses that can’t afford to spend on defense. Companies have been found to pay up to four times as much to resolve an attack than they would have to prevent one. As PHI is incredibly valuable, it will

With their 2020 nationwide expansion, 90% of Medicare beneficiaries will have access to a UnitedHealthcare Medicare Advantage plan. Through our close relationship with UnitedHealthcare, we’ve brought contracts to multiple facilities recently. If working with UHC is of interest to you, connect with us to see how our strategy may be mutually beneficial. View Article Here

On September 26th CMS released a Medicare Advantage (MA) Plan Memo updating specifics surrounding HIPPS code sets related to PDPM implementation, launching today, October 1, 2019. (Memo 1) These details are inclusive of iSNP and MyCare. The Memo relates to two previous CMS MA Plan Memos in 2014. (Memo 2) (Memo 3) More specifically, the

Research has found nursing home residents enrolled in UnitedHealthcare’s Medicare Advantage Institutional Special Needs Plans (I-SNPs) are significantly more likely to use skilled nursing services than those with a Medicare fee-for-service plan. For more on this, see this article from @mcknightsltcn. View Article Here

Skilled facilities and hospitals are observing patients with higher complexities being discharged to SNFs much sooner. Because of this, SNFs are trying their best to prepare for the rising acuity of patients coming in. This article from @skilled_nursing details the variances seen by geographic location, challenges expected and suggestions on how SNFs can partner with

The Centers for Medicare and Medicaid Services (CMS) will soon be replacing the Resource Utilization Group (RUG) Version IV payment model with the new Patient Driven Payment Model (PDPM). The current RUG-IV system focused on payments based on how much therapy services were received. However, PDPM places patients into case-mix groups based on certain clinical

Currently, Medicare beneficiaries must have a three-day hospital stay to receive subsequent fully covered skilled nursing services. Hospitals admitting on an observation basis rather than inpatient has lead to very costly Medicare denials. The American Health Care Association (AHCA) CEO has asked Centers for Medicare & Medicaid Services (CMS) to eliminate uncertainty on the Medicare

Managed Care is growing! Here is a look at the increase the five biggest Payers have seen in Medicare Advantage membership in the last year. Aetna leads the pack with an over 30 percent increase over last year. See the article below for this and more.   View Article Here

Rehospitalization is the most closely tracked metric for all payers. A recent Dartmouth study reduced RTH by 31%, predominately for LTC residents. For more on this, see this article from @mcknightsltcn: View Article Here

CMS has announced a new rule that will help Medicare Advantage plans to better compete with one another. This competition will be possible due to the types of benefits they will be able to offer next year including transportation, home environmental improvements and many more. For more on this, read the @HeartlandInst article below. View

Illinois identified the Medicaid application process and payments to providers as too slow. This article lays out how the state’s new law requires managed care organizations (MCO’s) to pay claims within 30 days while also streamlining the application processes ability to identify eligibility. View Article Here

Skilled Nursing Facilities are experiencing the necessity of a positive Payer relationship. Medicare Advantage plans are focusing on strategies that will have the greatest impact, affecting the most lives. To succeed, SNFs must learn to identify a Payer’s top priorities and build a solid foundation of communication, ensuring both parties are on the same page

This informative article sheds light on CMS Administrator Seema Verma’s opinion on Medicare Advantage as well as the perceived downfalls of single-payer, public option and Medicare-for-All. View Article Here

Payments have increased to the two Iowa managed care companies being paid to run the program this year. However, Iowa’s Medicaid Director notes that this should not be referred to as a raise, but as necessary due to rising costs the companies face as well as reflecting the increased payments legislator’s have determined for nursing

There is currently a New York state waiver amendment that would remove long-term managed Medicaid for patients living in SNFs. If approved, this would transition back into a fee-for-service Medicaid for stays over three months and would be implemented at the beginning of 2020. Other states could look to similar strategies as most states are

A national survey on healthcare markets revealed that skilled nursing facility properties demand may increase this year. This as opposed to 2018’s forecast which showed a steady or shrinking demand. For more on this please see the @mcknightsltcn article below. View Article Here

Skilled Nursing News sat down with the CEO of Dycora Transitional Health and Living to describe how the industry has changed through the years, to provide pointers for new SNFs and to elaborate on how a SNF can perform to its full potential. Focusing on your communities needs, telling your story, and being proactive rather

Two senators recently released a CMS list of nearly 400 nursing facilities nationwide with a “persistent record of poor care” whose names were not released publicly by the government. On this list, eighteen different Ohio facilities appear as Special Focus Facility (SFF) candidates, with an additional five already marked as SFF. For more on this,

The Trump Administration has finalized adjustments to Medicare Advantage and Medicare Part D to ensure patients have greater transparency in the cost of prescription drugs, along with improved visibility to their options. Under this new rule, the Explanation of Benefits document that Part D enrollees receive should now include notice of drug price increases as

Skilled Nursing Facilities are discovering that investing in their Staffing Star rating doesn’t necessarily lead to profitability. Rather, SNFs would serve better by focusing their attention on their survey and quality ratings, which show the biggest impact to their CMS five-star rating. This Star rating is indicative of the operating margin a SNF should expect

Through CMS’s proposed update to the prospective payment system (PPS) for the federal fiscal year 2020, SNF’s would see an increase in Medicare payments of $887 million. 2020 marks the implementation of the Patient-Driven Payment Model (PDPM), which focuses on clinical conditions as opposed to the volume of care provided. Under this model, CMS placed

The U.S. Department of Health and Human Services (HHS) revealed new voluntary programs that could overhaul the fee-for-service model, set to launch at the beginning of 2020. The first model is targeted towards small primary-care practices, while larger practices and health systems have other choices such as “professional” and “geographic” options. For more on this,

CMS Chief Seema Verma recently announced a “comprehensive review” of safety and quality standards for nursing homes. In this post, Verma highlights changes that have already been made, including stricter staffing requirements as well as aligning reimbursements with performance. Verma’s post reminds that the federal government will continue to overhaul its regulations for nursing homes

Approximately 36% of SNFs experienced a drop in stars this week according to the American Health Care Association (AHCA). With many providers losing one or more stars in quality, many SNFs trace this star decrease back to nurse staffing which has the greatest impact on quality. Quality has been a major focus as Centers for

While expenses continue to rise, revenue is declining for nursing homes according to a report provided by @MarcumLLP. This article from @skilled_nursing outlines how nursing homes arrived at an average loss of four cents per patient day in 2017. A combination of lower occupancy rates along with many residents now being enrolled in managed care

With the new PDPM model less than six months away, SNFs will need to continue to focus on their day-to-day deliverables to ensure their STAR rating, hospital readmissions and other details are not impacted. This article from @skilled_nursing notes how the transition from the RUG-based world to PDPM, a monumental payment overhaul, could easily steal

When contemplating what solutions might help SNF’s thrive in the future, one suggestion would be to evolve into a short-stay facility that would essentially cut the emergency room “out of the equation entirely”. This article from @skilled_nursing notes “the greatest opportunity” would be for SNF’s to partner with Medicare Advantage plans and prove their ability

Thanks to the care navigation that Medicare Advantage provides, consumers are experiencing value and simplicity. For several reasons, MA enrollment has increased over 30% in the past four years. A privately-run system rather than government-run, MA is proving to be valuable to consumers in both quality of care as well as financially. Through care navigation,

When the Patient-Driven Payment Model (PDPM) takes effect in October 2019, Payers using the RUG system will have until September 30, 2020 to adjust their rate calculations. With the variety of changes nearing, SNF staff will be forced to pay closer attention than ever before to their coding and billing. This article from @skilled_nursing sheds

During a discussion at a San Diego skilled nursing conference, former Speaker of the House Paul Ryan stated “I believe the future for Medicare is in the Medicare Advantage type of space”. In this conversation, Ryan praised Medicare Advantage plans as a means of preventing financial disaster to the Medicare program. Currently Medicare Advantage plans

According to the American Health Care Association and professional services firm Aon, nursing homes will see a 6% increase in liability claims this year, composed of a 3% increase in claims frequency and a 3% increase in claim size. Providing little to no write-offs, Access Advantage helps our members get the most possible dollars out

Choosing the right SNF is a very important decision for patients and families when transferring from the hospital. If a SNF that does not meet their need is selected, they run a much higher risk of re-hospitalization, longer length of stay and mortality. This article from @skilled_nursing details out how @UnitedHospFund and others are looking

Managed Care continues to grow! Read this fascinating article from @KaiserFamFound detailing facts about Medicare Advantage including state to state comparisons, statistics and much more! View Article Here

With a goal of saving taxpayers’ dollars and securing a better deal for the state, Gov. Mike DeWine has ordered the Ohio Department of Medicaid to rebid the state’s contracts with private health insurance companies manage health care dollars. This article from @daytondailynews sheds light on this and more! View Article Here

Though Congress is not obligated to incorporate such requests into actual policy, the Medicare Payment Advisory Commission has asked to reduce SNF funding by $2 billion in 2020. See more on this from the @skilled_nursing article. View Article Here

This year nursing homes should expect to see an increase of 6% in liability claims. This proving to be a big deal for LTC providers whose operating budget will be significantly impacted. This article from @mcknightsltcn details how this will affect them. View Article Here

ACO’s currently have up to six years to avoid taking risk under the current Medicare Shared Savings Program (MSSP). However, the “Pathways to Success” proposed by CMS would cut this timeframe to two years. See more on this in the article from @skilled_nursing. View Article Here

These are very challenging times for SNF’s. This article from @skilled_nursing details out suggestions for smaller SNF’s to stay afloat until the “silver tsunami” arrives. View Article Here

New reports show that Medicare’s hospital readmission reduction program may be causing an increase in mortality. Also under fire, rewards and penalties based on quality measures, due to their focus on processes rather than outcomes. This article from @modrnhealthcr expounds on whether or not quality incentive programs are working. View Article Here

Though many are calculating record-low occupancy rates, money continues to flow into skilled nursing facilities. For more on this please see the article from @skilled_nursing. View Article Here

Under new CMS guidelines, Medicare Advantage plans have more flexibility in 2019 with regard to the benefits they are permitted to offer. This report prepared by @millimanhealth and commissioned by @BMAlliance is one of the more comprehensive reviews that we’ve seen. View Article Here

For a detailed list of changes you can expect to see for SNF’s in 2019  please click below. View Article Here

For updates to Part B Therapy Thresholds which will be effective 1/1/2019 please click below. View Article Here

Access and our contracted strategic consultant, Avalere, have created a national map for use with leadership, staff and Board to assist in explaining the many Medicare PAC Pilot activities occurring. Access Innovations is participating in a Model 3 Bundled Payment Pilot with 12 PAC providers in Ohio indicated by blue dots. The April 1st Comprehensive