[2974] Contracting with MCOs: Benefit vs, Pitfalls
Education-Training Credits:
- 1.0 Hr(s) HCSSA Administrator/Alternate
Summary:The pros and cons of working with MCOs in and out of network.
HCSSA Topic(s) Addressed:
- §558.259[d][4]agency responsibilities
- §558.260[a][3]basic principles of management in a licensed health-related setting
- §558.260[a][7]financial management
Faculty:Spears, Jan
Program Description:
This program presents the pros and cons of working with MCOs in and out of network. As
traditional payor sources implement payment reductions, new payment models or move exclusively
to Managed Care, home health agencies are once again looking at the best way to work within the
Managed Care arena. Some MCOs can pick and choose their provider networks based upon
geographical area, STARs reporting, and pricing models. Medicaid MCOs typically offer below
market value contracts. Although the MCO must follow the home health rules, the payer can
establish additional requirements such as prior authorization, timeframes for physician signatures,
etc. that can be more stringent than the traditional counterpart. The avenues for appeals are
cumbersome and often leave the provider “holding the bag.”
Learn how to package your agency for
quality, cost and satisfaction in advance of seeking contracts with the MCOs in your area. Delivering
care in accordance with MCO requirements requires process modifcation for order development,
authorization management and billing. In addition, the presenter touches on best practice processes to improve
coverage and reduce days outstanding on your claims. Presentation Date: 11.15.2016
Learning Outcomes(s): Participants will actively engage in the activity and
indicate an intent to change or enhance their practice by delivering care in accordance
with Managed Care Organization (MCO) requirements while incorporating best documentation practices in order
to ensure coverage and reduce days outstanding on agency claims.
About the Presenter:
Jan Spears is Co-owner and Chief Executive Officer of MJS & Associates.
She has more than 30 years’ experience in the health care field. Ms. Spears has owned and operated a multimillion dollar home health care company as
well as consulted for over 300 homecare providers in 25 states. As a full time consultant for the past 15 years, Ms. Spears has successfully merged
clinical and financial strategies into successful operational plans for numerous providers nationwide. Jan serves as a Medicare coverage expert for
health care facilities who are undergoing audits by federal contractors through all levels of appeals. She has authored several publications and heads
a team of more than 25 consultants at MJS & Associates.
[2974] Contracting with MCOs: Benefit vs, Pitfalls
