Three Things to Prepare Your Agency for Medicare Advantage Inclusion

As most hospice agencies and providers know, 2021 could bring about significant change for the vast majority of the industry in regards to Medicare Advantage inclusion. Up to this point, the hospice benefit has not been included in plan participation, but CMS has indicated a hospice carve-in occurring as early as January 2021. Although the news will have massive implications for agencies across the country, there are actions that can be taken now to avoid being completely blindsided by the switch.

For background, Medicare Advantage is a plan patients can choose that provides benefits through a private-sector health insurer. Instead of enrolling in traditional Medicare, patients can select this option to receive different advantages. If Medicare does carve hospice in, which they say they intend to do in less than 12 months, hospice providers have several things to plan for, including various authorization processes, different payment rates and increased administrative costs.


We compiled a list detailing three parts of our plan that we will be implementing for clients in the upcoming months:


1. Check Patient Plans & Create a List: When a patient is admitted to your agency, your staff should immediately pull the eligibility file from Medicare. By looking at the file, you can see if the patient has chosen a Medicare Advantage Plan and the plan he or she chose, which is designated by a specific code.


We recommend starting a list of current patients and referrals that outlines their plans so you have an understanding of popular plans in your area and the number of your patients that have active MA plans. This guide will provide an estimate of revenue impact and some information regarding which plans you should consider becoming an in-network provider for.


2. Research Credentialing Processes: Once you have a compiled list of patient plans, research the accompanying codes to learn more about the insurance. We highly recommend visiting the credentialing sites now. Spend time familiarizing yourself with the guidelines and requirements to become an in-network provider. It is critical to get ahead of the curve if you choose to enroll in any of these plans.


3. Track Current Patients: We also suggest monitoring the statuses of your current patients to see how plan enrollments will grow and shrink throughout the year. How are plans changing and for what reason? This is going to provide great insight and will be especially interesting to track around open enrollment in the fall.


Overall, there are a lot of actions you can take now to estimate the impact on your agency. There are still uncertainties that will remain until implementation, but now is the time to be proactive. Most hospice agencies will undoubtedly run into some issues in regards to insurance companies failing to understand claims, bill types, etc., which is why all of these factors need to be taken into consideration to adequately prepare for what may come. 

Our team is ready to help your agency through the carve-in. Whether you are unclear about certain eligibility or identifying plan numbers, we are here to assist in any way we can. Call 888-737-3585 or email [email protected] to learn more!

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