It’s the rare issue where consumer advocates and nursing home providers are in near lockstep, but on this they passionately agree: Improved rules for Medicare Advantage plans made over the…

The healthcare landscape continues to evolve, and with it, so do the complexities of billing and reimbursement. Home health and hospice agencies face unique challenges, from managing PDGM requirements on…

A class action lawsuit was filed in November 2023 against UnitedHealth Group and a subsidiary alleging that they are illegally using an algorithm to deny rehabilitation care to seriously ill…

In this episode, Nicole Fallon, vice president of integrated services and managed care for LeadingAge, breaks down what we know about the future of MA. First up: What happens to…

A western New York health insurance provider for seniors and the CEO of its medical analytics arm have agreed to pay a total of up to $100 million to settle…

An increasing number of Medicare Advantage insurers are expected to institute nursing home co-pays starting Jan. 1, a change that could further hit providers already struggling to collect fair reimbursement…

Of the many significant factors affecting the skilled nursing industry in the last five years, Medicare Advantage was named as a major disruptor, as cost reports show a shift in…

Over the last decade, Medicare Advantage, the private plan alternative to traditional Medicare, has taken on a prominent role in the Medicare program. In 2024, nearly 33 million Medicare beneficiaries are enrolled…

Navigating the complexities of Medicare Advantage continues to be a sticking point for organizations trying to scale their business. In an education session at the 2024 Axxess Growth, Innovation and Leadership Experience…

On the campaign trail, both former President Donald Trump and Vice President Kamala Harris are eager to portray themselves as guardians of Medicare. Each presidential candidate accuses the other of…

Patricia Greene had spent a month recovering from a devastating stroke when her Medicare Advantage insurer, a unit of UnitedHealth Group, decided to stop paying for her nursing home. The…

Optum is scaling back its Medicare Advantage Special Needs Plans for nursing home and assisted living residents in several regions. The health care services arm of insurance giant UnitedHealth Group…

…On Oct. 24 a report from the US Department of Health and Human Services Office of the Inspector General was published that was just the latest evidence of how MA insurers pilfer…

Document. Don’t delay. Designate a handler. Those were among top tips provided by managed care and skilled nursing experts who have fine-tuned their approach to getting resident care approved by…

Dr. Steve Landers has long been eloquent in his speaking and writing about the importance of Home Health over the years. Though I was already impressed, I gained a new…

Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s…

Multiple states have been working toward a transition to managed Medicaid from the traditional state-run program, but there have been concerns about reimbursement timing and insufficient payment amounts due to…

In weathering the rise of managed care penetration – which has often meant lost profits – nursing homes are turning to centralized processes for handling claims, beefing up teams to…

Negotiating power with Medicare Advantage (MA) plans may become easier as nursing homes explore participation in bundled payment options such as the Transforming Episode Accountability Model (TEAM), which enables following…

GAINING CLARITY: This must-read for skilled nursing facilities dissects key trends shaping the 2024 Medicare Advantage landscape, directly impacting resident referral patterns and facility bottom lines.

There’s been a flurry of regulatory activity related to Medicare Advantage (MA) in the first half of this year, with many policy actions being the result of extensive advocacy efforts…

The Centers for Medicare & Medicaid Services should consider banning artificial intelligence from being used to deny Medicare Advantage coverage pending a “systematic review,” a group of 49 congressional leaders…

A bipartisan group of lawmakers is urging the Biden administration to prohibit Medicare Advantage insurers from using artificial intelligence tools to deny care until it completes a systematic review of…

Managed care is the dominant delivery system for Medicaid enrollees. The latest national Medicaid managed care enrollment data (from 2021) show 74% of Medicaid beneficiaries were enrolled in comprehensive managed care organizations…

The growing prevalence of Medicare Advantage (MA) plans in many skilled nursing markets has been a source of mounting challenges for operators, many of whom are wondering whether they can…