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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

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