Leaders suggest SNFs must treat managed care as a strategic operational priority – building dedicated infrastructure for denial management, contract tracking, and ADR response. Facilities that explore value-based levers such as TEAM model participation or I-SNP development will be better positioned to protect admissions volume, reimbursement rates, and payer relationships.
How To Survive Medicare Advantage In Home Health
Navigating the complexities of Medicare Advantage continues to be a sticking point for organizations trying to scale their business. Conlon and Korte began the session by examining how care is delivered under Medicare Advantage, highlighting the differences in care rates among beneficiaries.
— The Rowan Report, November 15, 2024
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 operating margins with more facilities struggling financially. Stephen Taylor said MA has had “one of the most profound” impacts on the sector, especially as it grew during Covid.
— Skilled Nursing News, November 19, 2024
Denied But In Denial No Longer: Providers Share Successful Medicare Advantage Strategies
The skilled nursing sector has lost millions of dollars annually as MA penetration has increased to 51% of all Medicare beneficiaries, while plans increasingly deny or limit post-acute care and sometimes make payments nearly impossible to collect.
— McKnight’s Long-Term Care News, November 1, 2024
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 the change. Payment portals unique to each managed Medicaid contractor is another hurdle to overcome, in addition to the Medicaid revalidation process currently underway.
— Skilled Nursing News, October 15, 2024
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 handle additional documentation requests (ADRs), and closely tracking contract renewals.
— Skilled Nursing News, September 27, 2024
TEAM Model Gives Nursing Homes Another Lever For Medicare Advantage Negotiations
Negotiating power with Medicare Advantage plans may become easier as nursing homes explore participation in bundled payment options such as the Transforming Episode Accountability Model (TEAM), which enables following patients through an entire episode of care.
— Skilled Nursing News, September 7, 2024
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
