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.