Headlines

UnitedHealthcare’s 2020 Medicare Advantage Plans To Expand

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

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CMS Memo- PDPM HIPPS Coding for MA Plans

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

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I-SNP Model Shifts Care To Less Costly Clinical Setting

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

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SNFs Prepare For Rising Acuity Of Patients

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

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What Is PDPM?

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

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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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