News

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.

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 memo clarifies the required submission of HIPPS coding on each MA enrollee SNF claim:

• The continued usage of previously approved HIPPS coding,
• New HIPPS coding, derived from the PDPM,
• Encourages payer communication distribution to providers and
• Provides a CMS source for additional information if needed.

Access Advantage has been in communication with each contracted Managed Care Plan since August. Last week we provided to our Member’s an updated roster confirming the October 1st adoption of PDPM by all Plans with the exception of Premier and Medigold. (See below chart)

We anticipate additional communications by Payers over the next several days and weeks and will update all Member’s as it becomes available. We will also update our chart accordingly, such that it will be useful as a staff reference.

Please let us know if you have any questions. Our Service Box at service@accesselite.com is routinely monitored throughout the day or you may contact Rachel Pfahler, Director of Network Development and Engagement at rachelp@accesselite.com for assistance.

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.

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 their hospital to help one another succeed.

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 characteristics.

This article from @SIAResearch does a fantastic job detailing out what this new model will look like and what Skilled Nursing Facilities (SNF’s) should expect.

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 three-day stay rule stating, “three days is three days”.

For more on this, see this article from @skilled_nursing.

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.  

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:

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.

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.