For years, says skilled nursing reimbursement expert Maureen McCarthy, managed care organizations have gotten away with denying appropriate care and denying or reducing payments to providers using less-than-ideal methods.
But a new federal rule governing Medicare Advantage payments aims to right past wrongs and ensure beneficiaries who need a skilled nursing stay can get it more easily. If it works, providers should also see a smoother path to the pay they’ve earned.
But it’s critical to understand what the new rule — going into effect June 5 — does and doesn’t do. Providers also must be on the lookout for payers who continue to try and skirt rules that are designed to equal the access afforded to all Medicare recipients and put in place more stringent requirements around preauthorization and diagnoses.
In this fast-paced but info-packed episode, McCarthy tells McKnight’s Long-Term Care News Senior Editor Kimberly Marselas how the playing field might be leveling out, at least a little.
