managing managed care during covid-19 - mueller...
TRANSCRIPT
1
Managing Managed Care during COVID-19
Presented by:Tiffany Karlin, Partner and Director of Healthcare Mueller Prost
Susie Mix, President and CEO of Mix Solutions Tuonisia Turner, Chief Operating Officer of Mix Solutions
Agenda
© 2017 | Mueller Prost PC | CAHF-South Bay | 12-18-15
• For the Providers that take managed care patients, what is
changing with COVID -19 crisis upon us!
• Where do we find this information?
• What do we do with it?
• What information are health plans requesting?
• Plan of attack
MANAGING MANAGED CAREduring COVID-19
For the Providers that take managed care patients, what is changing with COVID -19 crisis upon us.
• Codes, policies, authorizations, timelines, copay, guidelines, etc.• Reimbursement• Non-participating status being waived• What needs to be documented and communicated to health plan
MANAGING MANAGED CAREduring COVID-19
Where do we find this information?
Health plan/ MCO websiteProvider relations representative from health plan
State health care association/organization websites
Mix Solutions website [mix.solutions] (COVID-19 launching 4/19/2020)
Print information off health plan website (backup)
Please note: revisions and additions are happening daily
MANAGING MANAGED CAREduring COVID-19
Recent Updates:
MANAGING MANAGED CAREduring COVID-19
• 2 percent Medicare Sequester to provider payments. Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act temporarily suspends the Medicare Sequester from May 1, 2020 until Dec. 31, 2020.
• Aetna: Requirement for admission notification changed from 24 hrs. to 48 hrs. [4/14/20]
• CIGNA HealthSpring: (TX) No auth for OON admission, auth is 5 days, reimbursed at 70% Medicare allowable
• UHC: Claims submitted on or after 4/7/2020 providers may receive payment anywhere from a few days to two weeks earlier than usual.
• UHC: PT/OT/ST Reimbursement - UnitedHealthcare is temporarily expanding care provider telehealth access for Medicare Advantage, Medicaid, and Individual and fully insured Group Market health plan members by reimbursing claims for physical, occupational and speech therapists for certain services performed using live video-conferencing while a patient is at home. This change applies for dates of services from March 18, 2020 until June 18, 2020. Benefits will be adjudicated and claims will be processed in accordance with the member’s benefit plan and your participation agreement
What Do We Do With It?
MANAGING MANAGED CAREduring COVID-19
Cheat Sheet
Mock Claims
• Admission• Case Management• Business Office
Communicate to the team
MANAGING MANAGED
CARE during COVID-19
MANAGING MANAGED CARE during COVID-19
What Information health plans are requesting?
MANAGING MANAGED CAREduring COVID-19
Date of events
COVID-19 start dates
Reporting• Numbers of those confirmed positive test• Exposure presenting symptoms (Isolated)• Exposure no symptoms (Eval)
Dedicated wings
Policy and procedure (for COVID-19 and non COVID-19 patients)
Transfer information
Etc. etc.
Reporting/Tracking:
MANAGING MANAGED CAREduring COVID-19
MANAGING MANAGED CAREduring COVID-19
Plan of Attack
MANAGING MANAGED CAREduring COVID-19
• Top managed care plans we work with
• Managed care plans we want to work with
• COVID-19 Policy and Procedures
• Reimbursement rate
Extended LOA?
Amendment to current contract?
New contract?
• COVID-19 related costs (PPE, Isolation rooms, etc.)
What Would You Do? COVID-19 Patient Scenarios:
MANAGING MANAGED CAREduring COVID-19
Patient received SNF order, two (2) options given:
• ABC SNF [PAR]: release notification, admitting COVID-19 patients and has current COVID-19 patients
• 123 SNF [NONPAR]: will not be accepting COVID-19 patients
• Patient has made adamant decision to not seek care at SNF with COVID-19 patients
Facility has received referral for patient with UHC Medicare Advantage plan:
• Facility has UHC Medicaid contract• UHC will authorize all member stays during COVID-19 crisis, PAR and NONPAR• Reimbursement will be at 70% of Medicare allowable
• Admit?
Questions?
© 2020 Mueller Prost. All rights reserved. Not for further distribution without the permission of Mueller Prost. This publication has been prepared for general guidance on matters ofinterest only, ,and does not constitute professional advice. You should not act upon the information contained in this publication with obtaining specific professional advice related to yourspecific situation. No representation or warranty (express or implied) is given as to the accuracy or completeness of the information contained in this publication, and, to the extentpermitted by law, Mueller Prost does not accept or assume any liability, responsibility or duty of care for any consequences of your or anyone else acting, or refraining to act, in reliance onthe information contained in this publication or for any decision based on it.
Let’s Get Started!
Susie MixPresident/CEOMix [email protected]://www.mix.solutions/home.html
Tiffany KarlinPartner, Director of Healthcare [email protected]: 909-227-8553
Tuonisia TurnerCOOMix [email protected]