Thursday, September 22, 2022 at 2:00pm to Thursday, September 22, 2022 at 3:15pm Webinar/Teleconference
This presentation uses multiple extracts and examples of actual MA denials issues to Michigan providers. These address areas of F2F, orders, therapy services, and medical necessity.
Description
Medicare Advantage (MA) continues to increase penetration across the country with national 2021 enrollment topping 26 million- 42% of beneficiaries. This includes nearly 50% or Michigan (49.6%). Medicare Advantage plans expect home health to provide quality care for a lower cost. Many agencies see MA as a key component of their payer mix as they navigate the PDGM payment model changes. Along with the provision of care for these new payers comes the need for maintaining compliance with coverage requirements to retain payment for the care provided. With agency resources focused on OASIS E, Notice of Admission, and PDGM reimbursement it is easy to let MA compliance slip. While similar to traditional Medicare claims, MA plans often have differences that generate risk if the home health agency does not pay attention to them. This session covers the types of MA plans, common patterns of MA generated medial reviews, and agency actions to preempt denials in case of review. The differences between MA and CMS appeals processes are covered to afford this home health agency maximum chances of a successful outcome.
OBJECTIVES:
- Identify the 4 types of MA plans
- Identify the most common MA denials and agency education needed to prevent them.
- Define the main difference between MA and Medicare FFS/PDGM coverage requirements and how these are applied to medical review activities.
- Implement staff education and agency processes to minimize disruption from MA plan reviews.
COST:
MHHA Members: $95.00
Non Members: $190.00
PAYMENT/CANCELLATION POLICY
Payment must be made in advance of the program. Due to the expense of using the telephone/web hook-up, Webinar registrations may not be shared between agencies. Your registration covers the access of only one log in to the webinar. Handouts and related materials will be sent to you shortly before the program to the email address you provide. Refunds will be issued for those that cancel up to three (3) days prior to the program. Cancellations made less than 3 business days, or ‘no shows’ will forfeit the registration fee. Cancellations must be received in writing via e-mail.
Joe Osentoski, BAS, RN-BC
Joe has over 25 years in home health and hospice specializing in clinical quality assurance and regulatory compliance. He has been lauded by retired US Administrative Law Judge Robert Soltis in his book, How to Handle Your Medicare Hearing: “His credibility is beyond reproach”. Jos is the author of Home Health ADRs and Appeals Answers, First Edition, published by Decision Health
HANDOUTS
Handouts, evaluation forms, sign-in sheets and related materials will be sent to you shortly before the program to the email address you provide.
QUESTIONS?
Please contact Cindy Thelen, cindyt@mhha.org, 517/349-8089.
Information and Resources
Speaker
Joe OsentoskiLocation
WebinarFee Options for Time frames
EarlyNotification Email Link
Contact Email: Send Email to Cindyt@mhha.orgAdditional Resources
Additional Resources:
Download :
MA Review Registration Form