2 min read

[PR] Pathway Health Selected as Training and Implementation Partner for Managed Care MASTER Application

By Prime Care Tech Marketing on Wed, Apr 18, 2018 @ 01:59 PM

LAKE ELMO, Minn., April 18, 2018Pathway Health has been selected by Prime Care Technologies and its affiliate Managed Care Group LLC as their implementation, training and ongoing support services partner for their new app, Managed Care MASTER. Through this partnership, Managed Care Group will leverage Pathway Health’s vast network of more than 150 clinicians and technology experts to provide comprehensive implementation and training support.

“We selected Pathway Health due to its deep knowledge of the post-acute care continuum and nationwide network of expert consultants,” said Jim Hoey, Prime Care Technologies CEO. “As momentum builds for our best practice case-management solution, this partnership will enable us to better support our customers as they work to simplify their managed care processes.”

Managed Care MASTER utilizes best practices from 18-year managed care expert Mix Solutions, Inc. The case management and reimbursement app synthesizes data from managed care contracts, EMR systems and case management reports. Through the use of the app, skilled nursing care providers are empowered to maximize managed care reimbursement.

“We look forward to supporting Managed Care Group’s innovative application,” said Pathway Health Chief Executive Officer Peter B. Schuna. “As providers continue to implement strategies to improve patient outcomes while lowering costs, leveraging state-of-the-art technology will play an important role in providing quality, patient-centered care.”

About Prime Care Technologies 
Since 2003, Prime Care Technologies has equipped long-term care providers with flexible hosting, managed services and cloud software that evolve based on industry demand. Based in Atlanta with 150 employees and 200+ healthcare/IT partnerships, its technology-driven solutions are installed in 6,500+ facilities. With deep multi-vendor interoperability expertise, including the integration of 70+ healthcare applications and 3,500+ EDI payers, Prime Care Technologies offers the leading data warehouse and claims clearinghouse in post-acute care. Its affiliate, Managed Care Group LLC, has partnered with leading post-acute care vendors and subject-matter experts to develop software that drives automation and efficiency to the relationships between providers and managed care organizations. Synthesizing data from managed care contracts, EMR systems and case management reports, Managed Care MASTER empowers skilled nursing facilities (SNFs) to maximize managed care reimbursement. Learn more at www.primecaretech.com.


About Pathway Health

Pathway Health is a professional management, consulting, interim management, talent search, interim management and education services organization, serving clients across the post-acute care continuum. Since 1997, Pathway Health has been keeping a pulse on industry clinical, regulatory, quality and reimbursement trends to keep clients on the path to success. With over 150 experienced professionals, we engage and employ leading clinical and operational experts to assist our clients in achieving the next level of performance. Learn more at www.pathwayhealth.com.



Prime Care Technologies




Topics: MCO contract MCO claims contract management Pathway health Managed Care MASTER Managed Care Group case management for managed care case management support Prime Care Technologies Training and implementation partner managed care software managed care app
2 min read

Back to the Billing Basics in 2016 - Deductibles, Co-insurances, etc.

By Prime Care Tech Marketing on Thu, Jan 14, 2016 @ 06:26 PM

iStock_000036121056_Small.jpgIn the spirit of to our January 7, 2016 blog, we want to continue with the New Years’ resolution theme by concentrating on other important tasks every Post-acute Long Term Care AR manager should address. The following checklist can be helpful in steering your accounts receivables in a cash-positive direction for 2016:

  • Contract Management – Perhaps this is a good time to blow the dust off those payer contract file folders. Get to know the details and the impact they will have on cash flow for the next year. Do they include changes for 2016, such as reimbursement rates and contractual write-offs? Being familiar with and responding to such details can help AR managers more reliably predict payment requirements, amounts, and timing.
  • Co-insurance and deductibles – The ruleof thumb is if insurance is going to change, it will be at the beginning of the year. Specifically, check each payer’s copayments and deductibles. They typically seem to parallel Medicare guidelines which went into effect January 1st. The following table highlights some of these changes:

2016 Medicare rates at a glance

Part A Skilled Nursing Facility Coinsurance

$161 per day for days 21- 100 of Part A coverage

Part B Deductible and Coinsurance

Deductible - $166

Coinsurance – no change

Part C Rates

The rates and other billing terms are stipulated in the Medicare Advantage contracts

  • Patient liability – Not many states have fiscal years beginning on January 1, but in the event the states your facilities operate in do, then knowing what the patient liability rates will be and communicating them to Medicaid residents’ responsible parties will be helpful to collections. Even if the Medicaid fiscal year end is later, now may be a good time to review anticipated changes.
  • Contract folder and tickler file - If you haven’t already, we highly recommend that you set up a tickler file to effectively manage and track your payer contracts. Whether the tickler file is a traditional binder with physical folders or an electronic version, this is a good time to bring them up to date and to calendar critical changes and negotiation/renewal dates.

This list is small, but important. It will help you address not only these important revenue cycle management tasks, but also other tasks tied to your 2016 billing and collection goals.

Business Intelligence

Topics: contract folder Skilled Nursing Facility contract management co-insurance deductibles patient liability billing basics


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