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U.S. Senior Living and Skilled Nursing Facilities Adopt Hybrid Financial Models Amid Talent Shortages

U.S. Senior Living and Skilled Nursing Facilities Adopt Hybrid Financial Models Amid Talent Shortages

U.S. senior living and skilled nursing operators are increasingly adopting hybrid financial models to address persistent talent shortages and evolving financial demands. This approach combines internal finance teams with external resources, such as outsourced accounting support or fractional CFO leadership. The shift is driven by the growing complexity of the financial environment in healthcare, which includes navigating diverse reimbursement structures from Medicare, Medicaid, managed care organizations, and private insurance, each with distinct billing and compliance requirements. Additionally, the pipeline of accounting professionals is narrowing, making it difficult and costly for many organizations, especially smaller and regional providers, to maintain fully staffed finance departments with industry-specific knowledge. This hybrid model allows organizations to access specialized expertise, increase capacity, and supplement areas where recruiting and retaining talent has proven challenging, ensuring s...

House Ways and Means Committee Advances Buchanan Bill to Expand Medicare Coverage for Early Alzheimer’s Detection

House Ways and Means Committee Advances Buchanan Bill to Expand Medicare Coverage for Early Alzheimer’s Detection

The House Ways and Means Committee has unanimously advanced the bipartisan Alzheimer’s Screening and Prevention (ASAP) Act (H.R. 6130), co-led by Congressman Vern Buchanan and Congressman Paul Tonko. This legislation aims to provide Medicare coverage for FDA-approved or cleared blood-based biomarker tests for the early detection of Alzheimer’s disease and related dementias. Under current law, Medicare's coverage for preventive services is limited to those specifically authorized by Congress or recommended by the U.S. Preventive Services Task Force, which can cause significant delays in access to new screening technologies. Congressman Buchanan emphasized that early detection is crucial for families to have more time to plan and seek preventative care. The bill is supported by the Alzheimer’s Association and the Alzheimer’s Impact Movement and has garnered 215 bipartisan cosponsors in the House. Companion legislation has also been introduced in the Senate by Senators Susan Collins and Catherine Cortez Masto...

CMS AI Prior Authorization Pilot Plagued by Delays and Technical Failures, Documents Reveal

CMS AI Prior Authorization Pilot Plagued by Delays and Technical Failures, Documents Reveal

Documents obtained through a Freedom of Information Act (FOIA) lawsuit by the Electronic Frontier Foundation (EFF) reveal widespread issues in the Centers for Medicare & Medicaid Services (CMS) Wasteful and Inappropriate Service Reduction (WISeR) Model, an AI-powered prior authorization program. The roughly 1,000 pages of records from the pilot's initial months outline significant problems including thousands of delayed approvals, miscommunications between tech vendors and Medicare Administrative Contractors (MACs), and provider frustration. Many prior authorization requests exceeded the program's three-day goal, with some remaining unanswered for over 80 days. Providers reported patients experiencing severe pain due to delayed procedures. Technical issues, system downtime, and a lack of communication from vendors, particularly Innovaccer in Ohio, were also cited. The WISeR model, launched on January 1, aims to curb improper spending in traditional Medicare by using AI for prior authorization in Arizona, O...

Representative Kevin Hern Co-Authors Bill to Increase Medicare Spending Transparency

Representative Kevin Hern Co-Authors Bill to Increase Medicare Spending Transparency

Representatives Aaron Bean (R-FL) and Kevin Hern (R-OK) have co-authored H.R. 4093, the “Apples to Apples Comparison Act of 2025.” This proposed legislation aims to mandate the Centers for Medicare & Medicaid Services (CMS) to release more comprehensive data regarding Medicare expenditures and utilization. The objective is to enable policymakers and beneficiaries to more accurately compare the costs associated with traditional fee-for-service Medicare plans against those of private Medicare Advantage (MA) plans. Currently, Medicare spending exceeds $1.2 trillion annually, with over half of all Medicare beneficiaries opting for coverage through MA plans. The National Taxpayers Union (NTU) has expressed support for this bill, highlighting its potential to strengthen transparency for both beneficiaries and taxpayers. The bill is slated for consideration before the House Committee on Ways and Means on September 16, 2026.

Walmart and SCAN Health Plan Partner to Offer Co-Branded Medicare Advantage Plans

Walmart and SCAN Health Plan Partner to Offer Co-Branded Medicare Advantage Plans

Walmart and SCAN Health Plan Partner to Offer Co-Branded Medicare Advantage Plans

CMS AI Prior Authorization Pilot Faces Delays and Technical Failures, Documents Show

CMS AI Prior Authorization Pilot Faces Delays and Technical Failures, Documents Show

Documents obtained by the Electronic Frontier Foundation (EFF) through a Freedom of Information Act (FOIA) lawsuit reveal significant issues in the Centers for Medicare & Medicaid Services (CMS) Wasteful and Inappropriate Service Reduction (WISeR) Model, an AI prior authorization program. The roughly 1,000 pages of records from the program's initial months outline widespread problems including delayed approvals, miscommunication, and provider frustration. Thousands of prior authorization requests exceeded the pilot’s three-day turnaround goal, with some remaining unanswered for up to 83 days. The documents also detail miscommunications between tech vendors and Medicare Administrative Contractors (MACs), system downtime, and numerous complaints from providers about delays and lack of communication, particularly concerning the vendor Innovaccer.

Representative Tim Moore Raises Concerns Over Healthcare Fraud and Costs in North Carolina Hearing

Representative Tim Moore Raises Concerns Over Healthcare Fraud and Costs in North Carolina Hearing

Representative Tim Moore, representing Gaston County, voiced concerns regarding healthcare fraud and its impact on North Carolina families during a House Judiciary subcommittee field hearing in Charlotte. The hearing, titled “Examining Healthcare Markets: Fraud and Competition,” addressed various issues including mergers, certificate-of-need laws, regulations, vertical integration, and alleged fraudulent insurance practices. Moore highlighted that fraud and government subsidies might be contributing to the high cost and inaccessibility of healthcare in the state. He cited estimates suggesting that a significant portion of healthcare spending could be attributed to waste, fraud, or abuse. The discussion also touched upon the federal government's substantial contribution to ACA Medicaid expansion enrollees, which creates incentives for states to maximize federal payments, potentially leading to improper enrollments. Moore emphasized the need for increased competition and reform within the healthcare market t...

Why some retirees pay hundreds more for Medicare each month

Why some retirees pay hundreds more for Medicare each month

Medicare surcharges can catch retirees off guard. Learn how to manage your income to avoid paying extra costs.

Medicare Part D Plans Face Increased Financial Risk and Declining Options for Beneficiaries

Medicare Part D Plans Face Increased Financial Risk and Declining Options for Beneficiaries

Medicare's stand-alone prescription drug plans (PDPs) are experiencing significant challenges, including higher premiums and a substantial reduction in available options for beneficiaries. Between 2023 and 2026, the number of PDPs decreased by 55%, from 804 to 360 plans. This decline is partly attributed to the Inflation Reduction Act of 2022 (IRA), which restructured Part D benefits. The IRA increased the generosity of standard benefits, improving affordability for many but also leading to higher drug spending. Additionally, the IRA shifted greater financial liability to Part D plan sponsors, making their benefit costs less predictable. In 2025, Medicare significantly reduced its reinsurance payments to plans while increasing direct-subsidy payments, forcing plans to bear risk on 60% of brand-name drug spending above the out-of-pocket (OOP) cap, compared to 15% previously. This change, coupled with a lowered OOP cap, has created uncertainty for plans regarding future prescription fills and overall costs. ...

U.S. Citizens Over 65 Moving Abroad Face Complex International Health Insurance Decisions

U.S. Citizens Over 65 Moving Abroad Face Complex International Health Insurance Decisions

U.S. citizens aged 65 and older who are considering living abroad must carefully evaluate their international health insurance options, as Medicare generally provides limited coverage outside the United States. While some Medicare Advantage plans may offer limited emergency coverage during travel, routine healthcare overseas is typically not covered. This necessitates a thorough review of international health insurance plans, which vary significantly based on factors such as age, destination, medical needs, travel patterns, and budget. Decisions regarding whether to maintain Medicare Part A and Part B while living abroad are also critical, as delaying enrollment can lead to penalties and affect future access to U.S. healthcare services. The complexity is further compounded by age-related underwriting, pre-existing conditions, and the cost of international medical care, all of which influence available options and premiums.

American Hospital Association Urges Regulators to Broaden Scope in Hospital Merger Reviews

American Hospital Association Urges Regulators to Broaden Scope in Hospital Merger Reviews

American Hospital Association Urges Regulators to Broaden Scope in Hospital Merger Reviews

CMS Proposed Policy Changes Threaten Sustainability of Remote Patient Monitoring Programs

CMS Proposed Policy Changes Threaten Sustainability of Remote Patient Monitoring Programs

The Centers for Medicare and Medicaid Services (CMS) has proposed significant changes to the reimbursement policies for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services. These proposed changes, embedded within a draft Medicare physician pay rule, would restrict payment for RPM and RTM services to only those furnished by clinical staff directly employed by the practice, effective January 1, 2027. This means that third-party vendors, which many providers currently rely on, would no longer be eligible for Medicare reimbursement. The move is driven by CMS's concerns regarding program integrity and the quality of care provided by some vendors. Payments for remote patient monitoring have seen a substantial increase, jumping 31% from $408 million in 2023 to $536 million in 2024, with nearly 1 million enrollees receiving these services in 2024. CMS is currently accepting public comments on the Physician Fee Schedule (PFS) rule, having received nearly 40,000 comments to date.