Managed care plans typically hold all the cards when it comes to rate-setting. But a new way of analyzing billing data could finally give increasingly leveraged providers a better leg to stand on, financial experts say. The new analysis breaks out the data by per diem rate, length of stay, … Read More
The CORE Reporter: New perspective, better data
Medicare claims (UB-04s) are an invaluable source of SNF data. CMS releases quarterly “LDS” claim files which allow for Medicare utilization and market analysis. Third-party vendors offer useful tools that quantify referral patterns and performance metrics, but the data falls short in two critical ways. The first is timeliness; healthcare … Read More
Nursing Facilities Need to Weather the ‘Reimbursement Storm’ of Medicare Advantage
With Medicare Advantage revenue “significantly lower” than fee-for-service reimbursement, a new Zimmet Healthcare Services Group analysis says, skilled nursing facilities need to weather today’s “reimbursement storm” in order to make it to the incoming wave of baby boomers that will need facility services. In the meantime, Zimmet suggests operators utilize … Read More
The Rime of the New World Mariner Medicare Advantage & SNF Reimbursement
It is a New World Mariner, And he stoppeth wounded knee, With long grey beard and rehab needs, Now wherefore stopp’st thou he? Data, data everywhere, Still all our rates did shrink, Data, data everywhere, Yet all of it doth stink. Oh Fee-for-Service Medicare, How little hath we seen, Advantage … Read More
To Get Ahead of PDPM Audits, Skilled Nursing Facilities Target Top Areas of Payment Focus
When the overhaul of Medicare Part A reimbursement for nursing homes took effect in October 2019, predictions of audits and the potential for drastic changes came close on its heels. After all, the Patient-Driven Payment Model (PDPM) was meant to be revenue-neutral, meaning that the Centers for Medicare & Medicaid … Read More