Category: Medicare

Admission Discrimination

Payor Source McKnight’s had an article showing discrimination in the nursing home industry. The industry uses discriminatory tactics to reject less profitable residents. Ashvin Gandhi is an industry expert. Gandhi is a health economist and assistant professor at UCLA. Gandhi explained that existing law shows that disability discrimination is “clearly illegal” through the Rehabilitation Act,

Aduhelm (aducanumab)

Medicare officials are trying to determine whether to cover aducanumab or Aduhelm. Since last year, Medicare has been evaluating whether to pay for a new  expensive drug to treat Alzheimer’s disease. The F.D.A. approved the “miracle” drug. However, aout 40% of patients who have taken it have suffered swelling or bleeding in the brain. Alzheimer’s disease is twice

MedPAC to adjust PDPM

For an industry where profit margins are  widely discussed, financial transparency is nonexistent. For decades, the industry claims they cannot provide care under the old reimbursement models. However, the new Patient-Driven Payment Model (PDPM) model was not budget neutral. Therefore, the Medicare Payment Advisory Commission (MedPAC) suggested a modification to keep base payment rates budget

No More Surprise Medical Bills

“Surprise bills” are extra charges from a medical provider whom patients didn’t choose.  These medical bills add insult to injury. Surprise bills from anesthesiologists, radiologists, pathologists, assistant surgeons and laboratories were common before a new law “No Surprises Act” signed by Biden. As a nursing home attorney, we see clients shocked at the cost of medical bills.

Recalibrating Reimbursement

Data Metrics CMS continues to rely on nursing home’s self-reported and unreliable data for adjustments to the Patient Driven Payment Model (PDPM). PDPM went into effect Oct. 1, 2019. It was the biggest change to the nursing home reimbursement system in 20 years. Colleen Muncy is with data analytics firm StarPro. She told McKnight’s Long-Term

Jobs and Investment

Employment The Biden Administration will provide $500 million to the nursing home industry. The initiative will send strike teams to nursing homes to help with infection control and prevention efforts, and address staffing shortages. The strike team program will be a partnership between providers and inspectors that reduces the spread of infections at facilities. CMS


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