Category: Payment/economy

Key elements of ACO program overhaul

Source: The Bottom Line CMS finalized a rule with new requirements for accountable care organizations (ACO) last week, reducing the amount of time an ACO is allowed to stay in the program without assuming risk and expanding the three-day stay waivers for nursing homes. “Most Medicare ACOs do not currently face financial consequences when costs […]

PPS final rule increases agencies’ payments for 2019, finalizes PDGM

CMS has finalized a plan to launch a budget-neutral payment model for home health that utilizes 30-day payment periods and stops using the number of therapy visits to determine payment. That’s according to the 2019 PPS final rule posted Oct. 31 on the Federal Register website. The Patient-Driven Groupings Model (PDGM) will launch “on or […]

MedPAC publishes resource for SNFs: Payment basics

By The Bottom Line. MedPAC released their Payment Basics for SNFs 2018 report, which provides an overview of Medicare coverage and reimbursement. You can download this resource from The Billers’ Association resource library. The report includes a map explaining how reimbursement is calculated under the current prospective payment system, Medicare daily base rates for FY19, […]

Appeals backlog slowly reduced, percentage of unfavorable rulings concerning

By Home Health Line. While the backlog of home health appeals at the Administrative Law Judge level is steadily being chipped away, data show a low reversal rate for appeals. In 2018, 54,875 home health appeals have been dismissed. That is compared to 958 dismissals in 2017 and 731 in 2016, according to an analysis […]

CGS to hold webinar about RAPs

By Home Health Line. Medicare Administrative Contractor (MAC) CGS is holding a webinar 1 p.m. to 2 p.m. EST Nov. 15 to discuss a transmittal that provides instructions to MACs about monitoring home health agencies’ misuse of requests for anticipated payment (RAPs). “We will discuss the implications to you as a home health provider,” CGS’ […]

Study finds older Americans filing for bankruptcy at high rate

A new study available at SSRN shows that older Americans are struggling with increased financial risks, namely inadequate income and unmanageable costs of healthcare. The study concludes that the increasing baby boomer population entering into old age does not alone account for the significant rise in older Americans filing for bankruptcy. According to the study: […]

Resources for a smooth transition to PDPM

Brought to you by Biller’s Association for Long-Term Care. As SNF and nursing home providers familiarize themselves with CMS’ new Patient Driven Payment Model (PDPM), The Bottom Line is here to keep you educated and up to date on the latest resources, guidance, and best practices as they are made available. Here are this week’s […]

Two strategic responses to bundled payment models

Source: HealthLeaders Media Medicare’s bundled payment programs are profoundly impacting the way acute-care providers are working with their post-acute care partners. Hospitals and health systems participating in federal hip and knee replacement bundles are adopting two post-acute care strategies: limiting referrals to skilled nursing facilities and integrating with SNFs. For hospitals, establishing strong relationships with […]

Free webinar on PDPM

The new SNF payment rule is final. Learn what you need to do to prepare in HCPro’s FREE webinar. When: Wed, Aug 22, 2018 1:00 PM – 1:30 PM EDT Register here. The Patient-Driven Payment Model (PDPM) is designed to replace the current SNF payment methodology known as RUG-IV. The effective date of the change […]