Medicare Advantage: Evaluate, Leverage, and Monitor

Published in Member Communities on March 04, 2025

Kim Cuce'This post was originally featured in HME News.

Q. Do you have any key strategies to optimize working with Medicare Advantage plans? 

A. Here are a few recommendations that apply to navigating not only MAP plans but all insurances: 

1. Evaluate your order cycle process: Implement a comprehensive strategy to review the entire order cycle from intake to final payment. Address root causes such as inefficient intake processes, lack of knowledge about payer policies, and duplicate processes. Train customer service teams to identify qualified orders, understand authorization requirements, and communicate financial responsibilities to patients. Regularly measure performance, train staff, and adjust strategies to maintain a healthy revenue cycle. 

2. Leverage technology and automation: Maximize your core operating platform to save costs. Automation can improve efficiency in eligibility verification, prior authorizations, and timely filing with payers. Ensure your software setup (price tables) reflects current policies regarding allowables, authorization requirements, and quantity limits to reduce denial rates. 

3. Monitor and manage denials: Regularly review denial rates and write-offs to identify patterns and areas for improvement. Common avoidable denials include non-covered services, inconsistent modifiers, and lack of medical necessity. Implement strategies to address these issues and aim to reduce the denial rate to below 10%. Proper price table setup and company-wide education can help reduce denials. 

4. Consider the patient journey: Develop, implement, and monitor a patient pay financial policy to improve cash flow and reduce costs. This policy helps patients make informed decisions, preventing surprises. Additionally, consider "CareSelling" by offering cash options for items that enhance patient comfort, such as hospital bed sheets or wheelchair cushions. This approach not only improves patient experience but also increases revenue. 


TAGS

  1. medicare
  2. revenue cycle strategies
  3. vgm

From Our Experts

A Letter From the President: June 2025 thumbnail A Letter From the President: June 2025 Lindy Tentinger shares information on the VGM Heartland Conference, competitive bidding, new tools, and more. The Latest in Billing & Reimbursement from Ronda Buhrmester: Oxygen Equipment Updates and Reminders thumbnail The Latest in Billing & Reimbursement from Ronda Buhrmester: Oxygen Equipment Updates and Reminders Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement, shares updates on oxygen equipment groups. Maximize Your Heartland Experience: Tips, Tools, & Must-Knows thumbnail Maximize Your Heartland Experience: Tips, Tools, & Must-Knows Here's everything you need to know to ensure a smooth, successful, and unforgettable Heartland experience. Maximize Your Heartland Experience: Tips, Tools, & Must-Knows thumbnail Maximize Your Heartland Experience: Tips, Tools, & Must-Knows Here's everything you need to know to ensure a smooth, successful, and unforgettable Heartland experience. 2025 O&P Woman of the Year Nominations Now Open thumbnail 2025 O&P Woman of the Year Nominations Now Open The nomination period for the 2025 O&P Woman of the Year Award is open now through July 11. This award is open to all women who work in the O&P profession. Understanding the Value of ATP Certification and ATP Academy thumbnail Understanding the Value of ATP Certification and ATP Academy Becoming an ATP is a popular path often taken by occupational therapists (OTs), physical therapists (PTs), occupational therapy assistants (OTAs), physical therapy assistants (PTAs), and wheelchair technicians. With an ATP certification, one can both fill the needs of suppliers to sell certain wheelchairs and demonstrate that they have the skills and knowledge to complete their job as defined by the leading authority in the credentialing industry. Mobility Awareness Month: Celebrating the Impact of Mobility Providers thumbnail Mobility Awareness Month: Celebrating the Impact of Mobility Providers May is Mobility Awareness Month, a time recognizing the importance of mobility solutions, the professionals who provide them, and those who rely on them. Mobility Awareness Month: Celebrating the Impact of Mobility Providers thumbnail Mobility Awareness Month: Celebrating the Impact of Mobility Providers May is Mobility Awareness Month, a time recognizing the importance of mobility solutions, the professionals who provide them, and those who rely on them.