Headlines

CMS Requested To Simplify Three-Day Stay Rule

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

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MA Growth Of The Five Biggest Payers

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

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Payers Watch Rehospitalization

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

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CMS Will Help MA Plans Become More Competitive

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

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Medicaid Managed Care Bill To Expedite Claims Payment

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

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SNFs Looking To Improve Payer Relationships

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

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