Category: Skilled Nursing Facility

Post-Acute Wound Management and Patient-Derived Reimbursement Models

By: Roger B. Schechter, MD, Fellow of American College of Wound Specialists; Chief Medical Officer, Synergy Wound Technology Wound care has always been a considerable challenge in the post-acute setting. Patients with skin breakdown usually have a plethora of chronic comorbid conditions. Chronic wounds themselves, including pressure injuries, diabetic foot ulcers, venous leg ulcers, severe […]

Study finds half of SNFs to be unprofitable

Approximately half of SNFs are not operating at a profitable level, according to the 34th SNF Cost Comparison and Industry Trends Report, released on October 10 by consulting firm CLA. The report found that the 75th percentile of SNFs had an operating margin of 4.5% in 2018, while the bottom 25th percentile had margins of […]

AHCA raises concerns with CMS’ proposed abuse warning icon

Just a week after the CMS proposal to add a warning icon to the Nursing Home Compare pages of SNFs with a history of abuse, The American Health Care Association (AHCA) has called for a less severe logo. In an open letter to CMS administrator Seema Verma, AHCA president and CEO Mark Parkinson recommended a […]

CMS to flag SNFs with abuse citations on Nursing Home Compare

CMS announced October 7 its intent to display warning icons on the Nursing Home Compare website for SNFs with abuse citations. Beginning October 23, a red circle (see below) will appear on the individual pages for SNFs that received an abuse citation within the last year. SNFs that receive the abuse icon will also be […]

Therapist layoffs reported as a result of PDPM

Since the implementation of PDPM on October 1, thousands of therapists have been laid off, reports Modern Healthcare. The payment system prior to PDPM, RUG-IV, allowed SNFs to bill therapy services they deemed necessary, but some took advantage by ordering superfluous therapy services to gain additional reimbursement from Medicare. PDPM seeks to stop this practice. […]

CMS requiring hospitals to disperse SNF quality data to patients

CMS released a final rule on September 26 requiring hospitals to provide SNF quality reports to patients at discharge. These reports should include information about SNFs such as quality measures, star ratings, and readmission rates. To avoid favoritism, hospitals cannot legally recommend a preferred SNF to patients, so patients are often forced to locate a […]

DOJ pursuing criminal charges against SNFs that violate False Claims Act

The Department of Justice (DOJ) announced plans to pursue criminal charges against SNFs accused of violating the False Claims Act, according to Bloomberg Law. In the past, these violations have been treated subject to civil penalties, but the DOJ will now bring criminal charges against more egregious offenders. The False Claims Act penalizes providers that […]

CMS announces decline in 2020 Medicare Advantage premiums

CMS announced September 24 that “Medicare Advantage [MA] premiums in 2020 are expected to decline 23% from 2018 while plan choices, benefits and enrollment continue to increase.” This average monthly premium will be the lowest rate in 13 years. Accompanying this announcement, for the first time in a decade, a new Medicare Plan Finder was […]

MDS 3.0 RAI Manual Update

The new version of the MDS 3.0 RAI Manual, v1.17.1 are effective October 1, 2019 and  incorporates clarifications to existing coding and transmission policy; it also addresses clarifications and scenarios concerning complex areas. This version of the MDS 3.0 RAI Manual incorporates clarifications to existing coding and transmission policy; it also addresses clarifications and scenarios […]

Medicare improperly covered ambulance rides from hospitals to SNFs

The OIG reports that Medicare improperly paid $1.9 million to ambulance providers for transport from hospitals to SNFs from 2014 to 2016. As a result of this former study, the OIG released an updated report on September 11 regarding hospital-to-SNF transfer billing practices. The OIG audited 99 ambulance providers from 2015 to 2017 and found […]