Thursday, October 8, 2026 - Updated Daily
Thursday, October 8, 2026 - Updated Daily
Medicare Advantage V28 risk adjustment, tighter Star Ratings, and a flat rate are forcing plan exits in markets and a pivot to D-SNPs. This post is the follow-up to my previous post (https://rhislop3.com/medicare-advantage-snf-denials/)…by Reginald Hislop,…
Medicare Advantage SNF denials are frequently reversed on appeal while plans shrink coverage. The dual squeeze hits skilled nursing census and revenue. This is part II of a three-part series. Part I is here: https://rhislop3.com/medicare-advantage-regional-pullbacks/…
Medicare Advantage plan exits 2026 are shrinking rural coverage, with UnitedHealthcare and Humana leaving more counties than they enter, impacting patients…by Reginald Hislop, III Over the past several years the Medicare Advantage story has…
Recent healthcare billing fraud cases show similar conduct moving across bill coding, DME, telemedicine, and product billing. Read the provider-level analysis….by Reginald Hislop, III Earlier this week I wrote about CMS barring eleven medical…
CMS announced a $3.4 billion medical equipment supplier fraud scheme involving 11 suppliers and claims for deceased beneficiaries. Here is what it means….by Reginald Hislop III On September 8, 2026, CMS announced that it…
Medicare Advantage plans are paid through risk adjustment. The government sends each plan a fixed monthly amount per enrollee, and that amount rises when the enrollee’s record contains certain diagnosis codes. The system assumes sicker…
Healthcare reform is not a single bill. It is three separate changes moving through the federal system at once, and only one of them touches a skilled nursing facility’s day-to-day operations directly. Operators who treat…
Healthcare executive, consultant, and author covering post-acute care, senior living, and the economics behind both - for 30+ years.
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