Key recommendations from a panel of experts included inviting the plan in to your facility, designate a point person to work on every submission and monitor or renegotiate contracts regularly to avoid getting stuck with unfavorable rates.
Document. Don’t delay. Designate a handler.
Those were among top tips provided by managed care and skilled nursing experts who have fine-tuned their approach to getting resident care approved by Medicare Advantage plans — and getting those same plans to negotiate fair rates that they actually pay in a timely manner.
LeadingAge Vice President Nicole Fallon moderated an annual meeting session meant to give providers practical tools for working with plans. The skilled nursing sector has lost millions of dollars annually as MA penetration has increased to 51% of all Medicare beneficiaries, while plans increasingly deny or limit post-acute care and sometimes make payments nearly impossible to collect.
Berklan, J. M. (2024, November 1). Denied but in denial no longer: Providers share successful Medicare Advantage strategies – McKnight’s Long-Term Care News. McKnight’s Long-Term Care News. https://www.mcknights.com/news/denied-but-in-denial-no-longer-providers-share-successful-medicare-advantage-strategies/
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
