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Hosted by  Association for Long Term Care Financial Managers

A Road Map to Remedying MCO Bad Behavior & How to Fight Managed Care Denials

 
THIS COULD BE THE BEST INVESTMENT IN ACCOUNTS RECEIVABLE MANAGEMENT YOU MAKE ALL YEAR
 
 
 
 
  • Have you been wondering where all your Medicare patients have gone? In the last 10 years, the Medicare payer mix has been steadily shifting from Medicare to Managed Medicare.
  • How many times have you received an HMO authorization only to NOT be paid?
  • How many times have you received an HMO level of care authorization only to be paid at a lower level?
  • How many times have you not been paid on an HMO claim and thought “but I have a contract?”
  • How many times have you appealed through the HMO process outlined in your contract only to NOT be paid?
  • How many times have you thought “but who do the HMOs answer to?”

WE HAVE THE ANSWERS OR RATHER CHAD HAS THE ANSWERS. LET’S TAKE BACK CONTROL!
 
During this webinar, you will receive practical information that is going to bring in revenue and receivables! The competency you will learn will offset the cost of attending. Members receive a substantially reduced rate to attend.    Guests are encouraged to become a member for $85 for 2022-23 (4/1/22-3/31/23), get one month (March 2022) free membership and a reduced rate for this webinar.  https://altcfm.org/join
 
Once registered, you will receive an email from Association Office (customercare@gotowebinar.com) with call in and log in information.  As we get closer to the event, we will also send you tips, instructions and webinar rules.   If you are paying by credit card, please use the Pay Now buttons. We do not accept cards over the phone. If you are mailing check, use the Pay Now button and provide us with more information and check off sending check. Or, you may use the registration options at the bottom of this page.
 

Tuesday, March 15, 2022
12:00 PM - 2:00 PM

Location

Online using gotowebinar
   
 



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Agenda

 

Mar 15 2022 12:00PM


A Road Map to Remedying MCO Bad Behavior & How to Fight Managed Care Denials


Learn how to handle MCO level of care denials and retroactive cut letters—Knowing how to appeal and what to include is the key. Providers nationwide are seeing an increased number of MCOs discontinuing residents’ eligibility for skilled nursing care, with a majority of the notices lacking CMS mandated provisions for continued Medicaid coverage during the appeals process. Keeping residents qualified for Medicaid when it is evident that their care needs haven’t changed isn’t as difficult as it seems. In fact, the formula is simple. Learn what it is and how to implement each step.

Managed Care Delayed & Under Payments: Learn the most effective ways to cure both. Like every entity that touches Medicare/Medicaid dollars, MCOs are heavily regulated by both state and federal agencies, namely CMS and DOBI. When an MCO does not pay claims timely or underpays providers, the strategy is straight forward and effective. Sign up to learn how we successfully resolve these issues for providers throughout the country.

Learn how to handle MCO level of care denials and retroactive cut letters—Knowing how to appeal and what to include is the key. Providers nationwide are seeing an increased number of MCOs discontinuing residents’ eligibility for skilled nursing care, with a majority of the notices lacking CMS mandated provisions for continued Medicaid coverage during the appeals process. Keeping residents qualified for Medicaid when it is evident that their care needs haven’t changed isn’t as difficult as it seems. In fact, the formula is simple. Learn what it is and how to implement each step.

Here they come—Managed Care & MAC/RAC/SMRC, audit & recoupment notices are on the way. What you need to do now. To diminish the crippling effects of these audits, providers must timely appeal, assert rights recently clarified by both federal and state courts, and per CMS request any waivers and flexibilities in place during the emergency period.

How recent appellate court & ALJ decisions are advancing our unavailability of asset arguments: all assets are countable, but only available assets matter. sb2 has won several key cases that illuminate the scope of and how to use the CMS regulation on unavailability to obtain Medicaid eligibility, cure coverage gaps, and reduce resident income calculations.



Sessions

Continuing Education, per session, show accepted hours, or info about CE status. Hover over hours or info for details.


DateCourse Title/DescriptionStartCTADMIN
Mar 15, 2022 A Road Map to Remedying MCO Bad Behavior & How to Fight Managed Care Denials Chadwick Bogar, Esq. 12:00 P info