SNF Survey and Certification Update

When the 2025 Final SNF PPS Rule was released, the focus was on Medicare rate increases.  This is typically known as the “headline”. But as readers and followers here know, there is always a regulatory tidbit or two that can be even more significant in terms of operations, particularly as more and more Medicare patient … Read more

Litigation Breaks on CMS Staffing Mandate

As anticipated, litigation has started via various sources, in Federal courts, challenging CMS’ SNF “staffing mandate”. For specifics on the mandate and actual text, go here: https://rhislop3.com/2024/04/23/cms-final-snf-staffing-rule/ A big impetus behind the legal challenges to CMS mandate is the recent Supreme Court ruling known as the Chevron decision https://rhislop3.com/2024/07/01/scotus-chevron-decision-a-win-for-healthcare/ The decision overturns a longstanding doctrine … Read more

Doc Payment Fix in the Works?

Here’s an oldie but a goodie for today. The House Ways and Means Committee is reportedly considering a markup of legislation this month that would revamp Medicare’s physician payment system. This move could increase the likelihood of incorporating a “doc fix” into a lame duck legislative package. Historic readers and followers of Reg’s Blog will … Read more

Check: Medicare Advantage Coverage Issues

Late last year, CMS proposed a final rule to address the issue of coverage denials or service denials via prior authorization on behalf of Medicare Advantage Plans. Between providers and patients, coverage issues have significantly increased as beneficiary participation has increased (today, about 1 in 2 Medicare beneficiaries is in a Medicare Advantage plan). https://rhislop3.com/2023/11/09/cms-offers-fix-to-medicare-advantage-denials/ … Read more

Nursing Home Closures Creating Access Issues

With increasing older adult demand for hospital care, an ongoing wave of nursing home closures is creating post-acute access issues. Since 2020, 774 nursing homes have closed, and only seven new facilities opened in 2024. The primary driver for closure is a nationwide shortage of qualified clinical staff, exacerbated by the COVID pandemic.  The pandemic … Read more

Healthcare Fraud is Rampant and so are Costs

The U.S. spends more than any other world nation on healthcare – gross dollars and per capita. The systemic growth of spending continues at rate beyond inflation, spurred-on by an aging demographic and chronic diseases like diabetes and obesity.  Cost growth in programs like Medicare is rampant but then again, so is fraud. Federal spending … Read more

Exploring Age-Friendly Healthcare Programs

The Accreditation Commission for Health Care, Inc. (ACHC) has launched two new specialty credentials for organizations providing home care and/or hospice.  These programs are in line with the Age-Friendly Health Systems (Care) programs and initiatives started by The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association (AHA) and … Read more

TEAM Model and Post-Acute Care

The mandatory Transforming Episode Accountability Model (TEAM) will advance CMS prior work on value-based care models, including bundled care initiatives. The TEAM model (participation) will be mandatory for selected hospitals and participation “optional” for post-acute care providers. Transforming Episode Accountability Model (TEAM) | CMS The Transforming Episode Accountability Model (TEAM) is set to be a … Read more

Phantom Diseases and Medicare Advantage Fraud

According to a Wall Street Journal article from August 4, Medicare Advantage plans are using home nurse visits to identify possible or questionable disease states/conditions (so called, phantom diseases) via screenings.  These diagnoses then turn into what appears to be, possible events of fraud via additional reimbursement tied to these new-found conditions. Exclusive | The … Read more

Final 2025 SNF Rule – Rate Increase, More Fines

Under the Final 2025 (PPS) rule released last Wednesday, nursing homes are set to receive a 4.2% pay increase in Medicare Part A. Additionally, the facilities will encounter a stricter fines system, with civil monetary penalties being applicable in more situations. The Final Rule is available here: SNF Final Rule 2025 In April I wrote … Read more