Tips and Trends for Business Office Results
You remember the old days, when we had a little "HMO" billing? Now Managed Care is everywhere. Remember "Fee For Service Medicaid"? Well now so much of it is Managed Medicaid. Yes, the old days were simpler, but there's no point in nostalgia, we have claims that need to be paid in full.
They key to success with Managed Medicaid is being organized and getting it right from the start. Authorizations, Eligibilities, Dates of Service, Levels of Care, Claims, Codes and deadlines all need to be right, and the whole process needs to stay organized. A couple moretips:
Disenrollment. Some health plans cover for one month and then disenroll to State Medicaid. If you miss the window you could have unreimbursed days. Start the process on day one.
Coding Different health plans want different codes on their claims, even for the same service. Make sure you understand what goes where.
Timely Filing Deadlines can be as short as 90 days, and timely filing is very hard to overcome. If your timeliness window is closing, and you still don't have everything you need, consider billing for a (timely) denial then correcting your claim down the road.
Relationships are Important Put a smile in your voice, get on the phone and make some friends at the health plans. Having people in your corner makes a huge difference.
At LTC Consulting, our teams can help you handle Managed Medicaid challenges. We know the systems and the people and we can aggressively pursue and collect money for you. Managed Medicaid payers have been posing challenges for years, but the solutions are out there. Please reach out if we can be of service.