To Succeed with MA, Measure Performance Indicators, Guard Against Claim Denials, Experts Say

McKnight’s Home Care | By Adam Healy
 
As Medicare Advantage (MA) enrollment continues to grow, providers need strategies to best navigate this new payer landscape. Frontpoint Health CEO Brent Korte and Erin Masterson, associate principal of consulting at SimiTree, offered some of these during a session at the National Association for Home Care & Hospice’s (NAHC’s) recent Financial Management Conference in New Orleans. 
 
Currently, MA covers more than half of all Medicare beneficiaries, and the two experts estimate that the proportion will grow to over 70% by 2030. With this shift, the panelists said, providers have seen lower reimbursement rates, changing authorization requirements, a higher volume of claim denials, and an overall hard-to-navigate contracting and billing process with Medicare Advantage Organizations (MAOs).
 
MA plans generally have lower rates than Medicare fee-for-service, so the panelists agreed that agencies should look past revenue and instead modify their own cost structures. Finding ways to cut costs without cutting quality will allow providers to make more money without sacrificing the areas that make their agencies valuable to MAOs, they said. 
 
They also emphasized that providers should be measuring all of their performance indicators so that they can prove the quality of their services to MAOs. Focusing on measurements that MA plans value, such as being prompt in billing MAOs and not leaving services left unbilled, is the best plan of attack, they said.
 
“Know your numbers … because they think they know you better,” Korte said. Approach negotiations with an understanding of where your company succeeds, and “make them want you at the table.”
 
A higher rate of claim denials under MA means that providers should build processes to safeguard against them. Patients’ insurance should be reverified every month to limit any risk, they said, and staff members in charge of billing MAOs should be unwilling to accept denied claims. Masterson suggested incentivizing those employees who help to protect against low rates of denials. After all, $200 spent on incentive bonuses is a small cost compared to thousands lost when payers refuse claims.
 
“It’s worth a couple hundred bucks for the incentive if because of that we’re collecting a hundred thousand more, or two hundred thousand more,” she said.