InsuranceGuy29
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‘Elephant in the Room’: Medicare Advantage a Huge Factor in CCRC Decision Making Around Nursing Home Services
Soaring costs associated with skilled nursing – and problematic payer sources – are making it harder for continuing care retirement communities (CCRCs) toskillednursingnews.com
Moreover, with the growth of Medicare Advantage plans, which are linked to a higher rate of denial of skilled nursing services and delays in payment, CCRCs providing skilled nursing services may be forced to pare these down or cut them out completely, said Phil Chuang, senior vice president of healthcare services at HumanGood. Medicare Advantage is the “elephant in the room,” Chuang said, when it came to decision making around scaling back skilled nursing services from the CCRC.
MA plans currently reimburse 60% to 80% of what Medicare Fee-for-Service reimburses.
Good. Skilled nursing facilities are consistently some of the biggest culprits of Medicare scams. They love original Medicare because there's very little oversight. These huge extra scam-costs are costing Medicare recipients/taxpayers tons of extra money.
When I first got in the industry I was completely naive. I got a call from some shady lady that ran one of these small nursing facilities. It catered to folks that mentally had special needs. The folks had no clue what was going on. They all had good MA policies though.
She wanted me to switch all of them out of their MA plans and put them on OM. At the time I was very confused and had no clue why she would want that, considering they had plans that protected them with the MA plans.
After seeing her and hearing her talk, she just came off as cold and like a complete bitch. So I told her I would think it over. I went back to my mentor and she said don't do it. They ended up having a screaming match on the phone, and my mentor told her never try this crap again.
The lady was only doing it to get more money out of them.
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