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Managing Medicare Advantage Reviews and Appeals Webinar


Thursday, September 22, 2022

2:00pm to 3:15pm



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:

  1. Identify the 4 types of MA plans

  2. Identify the most common MA denials and agency education needed to prevent them.

  3. Define the main difference between MA and Medicare FFS/PDGM coverage requirements and how these are applied to medical review activities.

  4. Implement staff education and agency processes to minimize disruption from MA plan reviews.

 

Dealing with the Challenges of Medicare Advantage?


MA payers have an aggressive medical review process in place and can cause your agency's hard earned payment to leak out the bottom of your financial bucket. Knowing what MA plans in Michigan are looking at and how to respond to MA reviews is key to minimizing this. Understanding the limits of their appeals process and getting the right content in the record at time of service is a key defensive action to take. This webinar addresses types of MA plans, the current MA medical review environment, and uses many ACTUAL MA review findings from Michigan agencies to demonstrate what can be done to prevent denials.


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