Managing Medicare Advantage Contractsfor Profit & Efficiency

BlackTree Recommends

Know your market – it may differ from the global MA demographics!

Less than 100 44%

17%

11%

6%

17%

6%

100-250

251-500

501-1,000

1,001-5,000

5,000+

Currently serving MA population – contracts achieve desired margin 19%

63%

13%

6%

Currently serving MA population – looking to renegotiate contracts

Looking to expand and negotiate contracts

Benefit not offered yet

Create a payor matrix to document the nuances of each payor

Revenue Cycle Solutions

Webinar Poll Results:What is the estimated size of your MA population?

Webinar Poll Results: What best describes your current presence in the MA landscape?

MA expansion of benefits is leading to fast growth in MA enrollment

Understand the operational challenges unique to MA

Know your worth as a provider when negotiating withMA plans

Be informed and negotiate accordingly

PProviders are key to payor education

Key Takeaways

Customize your EMR and clearinghouse to meet different billing requirements

Strategize document management and collections efforts by payor timely filing limits

Structure authorization assignments by payor to develop staff expertise:authorization is a top write-off reason for MA

”We’re really focusing on the best protocols that you can negotiate with your payors, and once you have those protocols set in place, how are you geing to know your payors so that you can uniquely manage to

each of their individual nuances.”

– Samantha Soulas, BlackTree Consulting Manager

Managing Medicare Advantage Contractsfor Profit & Efficiency

BlackTree Recommends

Reimbursement rates 50%

33%

6%

11%

Increased denials/cash flow delays

Authorization needs

General Uncertainty

Determine your costs and negotiate rates based on desired margins

Managing Contracts

Webinar Poll Results: What is your biggest concern with current MA plans/future adoption of MA plans?

Negotiate favorable terms for authorization, timely filing limits, etc.

Demonstrate your value to the payor – social determinants of health, inpatient readmissionreduction, specialty programs, etc.

Opt for 2-year contracts over evergreen contracts – easier to negotiate incremental rate increases

Be organized in contract management and reevaluate aged agreements

Keep your agency’s information current with the payor – ease of doing business!

“Once these partnerships are formed and these relationships are built, (payors) then rely on you and are comfortable with you to come to you as a resource, which is really important and a value add because

then the road goes both ways.”

– B– Beth Ann Morren, Elara Caring VP, Managed Care

PDGM 44%

6%

39%

11%

PPS

Per Visit

Other

Webinar Poll Results:What is the primary reimbursement method for your home health MA plans?