Skilled Nursing News October 1, 2019
Skilled nursing providers looking for a simple answer to how managed care plans will react to the new Medicare payment model will likely have to face an inconvenient truth: It’s complicated.
Private Medicare Advantage insurers didn’t have to follow the old Resource Utilization Group (RUG) model when deciding how to reimburse for skilled nursing services, and they don’t have to abide by the new Patient-Driven Payment Model (PDPM), either. Some will and some won’t, and it’s up to each operator to seek and receive firm answers from their managed-care partners.
“Bottom line: MA plans can do whatever they want,” Marc Zimmet, president of Zimmet Healthcare Services Group, told SNN.
In his experience so far, the proactive plans —...
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