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Maximize Reimbursement with Managed Care Checklist

By Prime Care Tech Marketing on Sun, Oct 11, 2020 @ 07:00 PM


The days fly by so fast; we suspect excellent articles like this one from Skilled Nursing News do as well. In All Or Nothing for SNFs: ‘Managed Care Is Not Something You Can Dabble In,' experts from Blue Sky Therapy and BKD are interviewed. We compiled their advice into a one-page checklist to help you maximize your managed care reimbursements.

If you prefer to keep reading versus downloading our checklist, here are the highlights:

  1. Establish authorization process with therapy partners 
  2. Take an inventory of managed care contracts 
  3. Communicate contract terms to staff - reimbursement criteria, pay types, delivery of care mandates, authorization requirements 
  4. Determine method of reimbursement - PDPM, visit rate, old RUG model Review inventory for outdated contracts 
  5. Research and target new payers - review declined admissions/payer out-of-network or CMS list of payers with highest local enrollment. 
  6. Stay on top of CMS Five Star ratings - minimum three stars to negotiate with MCOs; five stars likely required in metro areas 
  7. Monitor your outcomes - readmissions, discharge to home/hospice /other, average length of stay, admissions by insurance company 
  8. Compare your stars and outcomes to competitors 
  9. Diligently document care - a top reason for denial is neglecting authorization of care requirements 
  10. Seek out forums with hospital liaisons and competitors to jointly address various payer issues 

We can't say it enough – technology can help! Our Managed Care MASTER was designed to address nearly everything on this checklist. We did a 30-minute recorded demo of it just last month if you'd like to check it out, or get in touch for a live demo.





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