Adapting your Operations for Medicare Advantage Plans is proudly presented to you by National Association for Home Care & Hospice. Thank you. We hope that you enjoy your course.
As Medicare Advantage plans increase their enrollment in your market, it is important for agencies to know how to adapt to the requirements of Medicare Advantage plans. These plans may have contractual obligations like prior authorization of services and post-payment reviews that differ significantly from traditional Medicare. In addition, there may be specific billing requirements, including time limitations, in order to get paid on a timely basis. As a result, agencies should develop appropriate processes for referral management and billing in order to create clean claims. Due to these requirements, which may vary by plan, it is important to know your costs specific to each plan. This costing will allow agencies to determine profitability by plan and seek payment adjustments for plans that cost more. This session will focus on how an agency can identify process changes that need to be made in operations in order to successfully adapt to Medicare Advantage plans. It will review some of the challenges related to managing referrals and generating clean bills for these plans. This session will also provide you with the tools to develop a way to identify the cost associated with each contractual requirement like prior authorization. Finally, this session will outline initiatives in a few states to operate plans for the dual eligible population that may threaten an agency existing Medicare volume.
Learning Outcomes:
• Identify contractual requirements of Medicare Advantage plans that differ from Medicare and require new procedures and provide guidance on how to determine costs for each program
• Provide the tools to effectively manage Medicare Advantage referrals, including prior authorizations
• Relate how certain states developed plans for the dual eligible population that may reduce your current Medicare patient volumes
Faculty:
Todd Montigney
Walter Borginis III, CPA, MBA, CGMA, FCPP