The Discovery Health Partners team spent some time earlier this week digging into Medicare at the Health Education Associates Medicare Accounting and Reconciliation conference.
We were certainly excited to escape the snow and cold of the Midwest with a couple of days in Florida, and we were (almost) as excited to hear what our health plan partners were talking about when it comes to better managing the financial impacts of Medicare. And, once we cracked the Medicare code (all of those acronyms are impressive!), the amount of information and networking packed into this one-and-a-half day conference was insightful, engaging, and fun.
As a chairperson for the conference, I had the opportunity to get to know our speakers and have a front row seat for some great presentations. Here are just a couple of things we heard about:
- Compliance is necessary, even when the ROI isn’t obvious. Finding a way to sync your activities with the sometimes challenging CMS calendar is critical to running a compliant MA plan.
- Accurately calculating member revenue requires an investment in understanding ALL of the factors that affect your payments, checking and rechecking for errors, and appropriately prioritizing your efforts against potential ROI.
- Resolving discrepancies with effective SOPs can be done with the proper management of Category 2 and Category 3 submissions, daily reconciliation, and again, a working understanding of the CMS calendar and the gaps it creates in timing.
- Leveraging technology to simplify processes like MSP validation that can reduce the amount of resources required to run an efficient and effective program.
- Learn from each other! Sharing victories, and more importantly challenges, is critical to success. Share case studies and leverage your peers to deepen your understanding and enhance your program’s performance. If you’d like to be a part of our MSP conversation, please join our MSP LinkedIn group.
In addition, our very own Vice President of Operations, Laura Cohen, presented five tips for improving your MSP validation and premium restoration process.
1. Align commercial and Medicare Advantage eligibility
- Communicate termination dates to CMS
- Avoid paying primary claims, while receiving secondary premiums
2. Understand how much revenue is at risk
Use our calculator (insert link) to identify your potential outcomes
3. Implement best practices
- Identify and prioritize open records
- Validate correct other coverage
- Submit updates to CMS
- Update eligibility information
- Track, monitor, and reconcile financial impact
4. Evaluate technology
- Management insight and control
5. Consider outsourcing
- Get started quickly; adjust to changing work demands
- Gain the focus and dedication this process requires
- Access subject matter experts
- Leverage proven processes and technology
Laura has lent her expertise in this area to 12 plans over the past 18 months and the results she and her team have been able to achieve have been staggering. They have helped our clients restore a total of over $77 million and improve their processes for ongoing revenue optimization.
As Laura mentioned, even plans who are doing an excellent job of managing their MSP Restoration process find significant dollars when they partner with our team.
We look forward to seeing you at one of our upcoming conferences this year!