In weathering the rise of managed care penetration – which has often meant lost profits – nursing homes are turning to centralized processes for handling claims, beefing up teams to handle additional documentation requests (ADRs), and closely tracking contract renewals.
Rates for managed care plans like Medicare Advantage are often lower than traditional fee-for-service Medicare rates, and given higher administrative burdens associated with managed care along with delays or denials of service, nursing homes have suffered financial loss from managed care’s growth. While centralization of managed care claims is some operators’ way to deal with the problem, others in the space have used Institutional Special Needs Plans (I-SNPs) to reduce managed care burdens.
Stulick, A. (2024, September 27). Inside Covenant, American Health Plans’ strategies to keep nursing home managed care burdens in check. Skilled Nursing News. https://skillednursingnews.com/2024/09/covenant-american-health-plans-on-strategies-to-keep-managed-care-burdens-in-check-for-nursing-homes/
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
