Medicare Advantage Proves To Be the ‘Most Profound’ Disruptor for Nursing Homes

[Northeast Agent]

Medicare Advantage Proves To Be the ‘Most Profound’ Disruptor for Nursing Homes, Reshaping Payer Dynamics

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

skillednursingnews.com

Major payer, major burden​

From an episodic perspective MA in many states is becoming the major payer, Taylor said. However, this is also creating a huge administrative burden for nursing home operators, as well as complicating the understanding of the dynamics behind referral sources and the management of episodic patients.

MA reimburses on average 20% to 30% less than traditional Fee-for-Service Medicare. And while there may be occupancy gains with MA enrollees, there isn’t the same amount of financial benefit, Taylor said.

“A shift from Medicare to managed care erodes average revenue per patient day, but the staffing levels required to deliver that care plan remains the same. It just means trimmed margin,” said Wilson.

 

[straightnochaser]

A client called yesterday saying his SNF canceled his d-snp plan because "you can stay longer and it's easier for us to get paid by medicare" He literally couldn't believe it and I resigned him up for a Dec 1st start date...

 

[Special Agent]

A client called yesterday saying his SNF canceled his d-snp plan because "you can stay longer and it's easier for us to get paid by medicare" He literally couldn't believe it and I resigned him up for a Dec 1st start date...

I have learned to expect this to happen if an MA client goes in SNF.The admin at the SNF never discuss the dark side of switching over to original medicare only

 

[straightnochaser]

I have learned to expect this to happen if an MA client goes in SNF.The admin at the SNF never discuss the dark side of switching over to original medicare only

He was only scheduled there for about ten days, approved by uhc.. they clearly want to extend his stay as long as possible but he's ready to go... scummy practices and I'm supposed to feel sorry for these people? nahhhh

 

[InsuranceGuy29]

A client called yesterday saying his SNF canceled his d-snp plan because "you can stay longer and it's easier for us to get paid by medicare" He literally couldn't believe it and I resigned him up for a Dec 1st start date...

I've encountered this countless times in the industry. I literally had to call one and tell them that they aren't insurance professionals and to stop giving insurance advice to MY clients. They wanted my client to stay basically indefinitely, even though he was telling me he felt fine, and to change his plan to one that benefits them. For those that don't know, skilled nursing facilities are one of the biggest perpetrators of Medicare fraud. This is what insurance does...it negotiates the obscene costs that medical facilities charge, down, so that they pay less and we pay less as beneficiaries. The full retail cost of one month in a skilled nursing facility is almost $10,000. It's obscene.

 

[axeman462]

I've encountered this countless times in the industry. I literally had to call one and tell them that they aren't insurance professionals and to stop giving insurance advice to MY clients. They wanted my client to stay basically indefinitely, even though he was telling me he felt fine, and to change his plan to one that benefits them. For those that don't know, skilled nursing facilities are one of the biggest perpetrators of Medicare fraud. This is what insurance does...it negotiates the obscene costs that medical facilities charge, down, so that they pay less and we pay less as beneficiaries. The full retail cost of one month in a skilled nursing facility is almost $10,000. It's obscene.

there are some here that would insist that Medicare Fraud doesn't exist