How Reimbursement Cuts Affect Margins
Learn how reimbursement cuts affect margins in post-acute care, from fixed costs and labor pressure to service-line decisions and strategic responses.
PPS
CMS Changes SNF Surveys With New Risk Surveys
CMS modernizes nursing home oversight with new risk-based survey approach, shifting federal scrutiny toward facilities where resident harm is most likely.
Update on Medicare Site-Neutral Payments
A guide to Medicare site-neutral payments for healthcare leaders: the policy, financial exposure, and operating decisions that could reshape care delivery.
Site Neutral Payments Kick-0ff!
As of January 1, 2026, the scope of Medicare’s site-neutral payment policy expands to include drug administration services—such as chemotherapy and other infused therapies—furnished in excepted (grandfathered) off-campus provider-based departments (PBDs) of hospitals. Under the CY 2026 OPPS final rule published by CMS: CY 2026 OPPS and Ambulatory Surgical Center Final Rule – Hospital Price … Read more
CMS Releases Home Health Final Rule 2025
On November 1 the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year 2025 Home Health Prospective Payment System (HH PPS) final rule, which updates Medicare payment policies and rates for Home Health Agencies. Unlike other Medicare provider types that have PPS rule updates corresponding to the federal fiscal year (10/1), home health … Read more
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
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
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
Medicare, DOJ, Fraud and the Eclipse?
Happy Eclipse Monday! The post title is meant as a bit of fun but there is a bit of relevancy as well. Billing fraud occurs via a process of hiding what actually has transpired (or should have) with the care of a patient. The most typical fraud is overbilling or charging the government for care … Read more
CMS Releases 2025 PPS Proposed Rule for SNFs
It’s that time of year again where CMS begins to drop various rule proposals for updates to provider groups under PPS. From Hospitals, to SNFs, to Home Health and Hospice, each industry segment will see a proposed series of rate and programmatic (rule) updates from CMS. This is normal and it occurs at about the … Read more