Maximizing Managed Care Organization (MCO) Collections
Providers struggle with Managed Care Organization (MCO) reimbursement during Managed Care transition and this can continue long afterward. Thin margins in our industry magnify the impact of this. Denials prevent timely and complete payment, impacting cash flow and resource requirements in the Revenue Cycle department. The learning curve is often very difficult, especially when dealing with multiple payers with different systems and processes. Appropriate up-front management of the Revenue Cycle can serve to minimize payer denials, thereby improving payment throughout and required “re-touches” to get claims paid, and minimizing write-offs.
This webinar will help enable Home Care, Home Health and Hospice Agencies working with Managed Care to collect the highest percentage of billing from MCO’s in the shortest timeline, through ensuring claims are as clean as possible, and follow-up is consistent and timely.
Objectives:
1) Intake – authorization management
a. Reading and interpreting payer authorizations
b. Verification of unit computations
c. Providing services to authorization specs
d. Managing re-authorizations
2) Eligibility – manage who is the correct payer
a. Regular eligibility checking
b. Medicaid eligibility and impact on current MCO payer
3) Procedure code issues
a. Matching to payer contracts
b. Using correct modifiers
4) Split shifts – ensure they are billed together
a. Procedures to bill
5) EDI Rejections
a. Minimization
b. Timely follow-up
6) Metrics and Management Tools
See Program for Details
Presenter:
Phil Feldman, Vice President, Revenue Management Solutions at Sandata Technologies
Phil is a CPA with over 16 years in home healthcare in financial and operational roles. Phil spent seven years as Vice President of Operations, and Vice President of Contracting and Legislative Affairs of a large Health Care Service Firm in New Jersey. Phil also spent seven years with a large national skilled home healthcare provider with roles in financial operations, revenue cycle management, and payer receivable workout negotiations.