Nursing homes have historically had little leverage in negotiations with Medicare Advantage plans, even as MA has come to cover an ever-larger number of skilled nursing beneficiaries.
Many skilled nursing providers are still underusing Interim Payment Assessments under the nascent Patient Drive Payment Model, but one new pressure is driving some to submit those extra patient evaluations even when it will cost them.
Providers still struggling to accurately capture diagnoses that drive federal reimbursement will be doubly left behind as more states start to use Patient Driven Payment Model-like systems to determine long-stay Medicaid pay rates.
Managed care plans typically hold all the cards when it comes to rate-setting. But a new way of analyzing billing data could finally give increasingly leveraged providers a better leg to stand on, financial experts say.