Skilled Nursing News August 13, 2024
Delivering care to dual eligible nursing home residents can be complex with so many payers involved in the industry, but aligning incentives, quality measures and tools for providers can help operators serve this demographic.
Dual eligible residents, or those that can receive benefits from both Medicare and Medicaid, often find themselves in a “tangled web of conflicting program rules,” said Allison Rizer, executive vice president of payer solutions with ATI Advisory. There are different provider networks, different enrollment periods, different requirements for getting a benefit covered, and different coverage documents are needed, she said.
“It’s extremely confusing and overwhelming,” said Rizer. “This system fragmentation leads to poor outcomes and inefficient healthcare utilization, and higher costs overall for both the Medicare...
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