Healthcare business graph and data overlay wiht medical professional in the background

By: Bernadette Smith, Managing Director, LTC 100 Intelligence Group

Chad Bogar, Managing Partner of sb2, recently sat down with David Ellis, Founder & President of Lincoln Healthcare Leadership and the LTC 100 Intelligence Group to discuss various widespread MCO issues that providers are currently facing and how to remedy bad MCO behavior. First, Chad discusses how to gain control in your relationship with MCOs. Here's part one of LIG and sb2 on Changing MCO Bad Behavior:

How to Gain 10-30% More Revenues from Your MCOs.

Chad estimates SNFs get underpaid by 10-30% from MCOs by not being paid timely, inadequate MCO billing systems, inappropriate deauthorizations and other negligence.

He recommended five ways to turn the tide in our favor vs. MCOs:

Know MCO Fears. MCOs have two "bosses" – the state agency that governs insurers, often called the Department of Banking and Insurance (DOBI), and CMS. Whenever you have a problem with MCOs, you need to go to their bosses, DOBI and CMS – that gets their attention and action. And don't be afraid to use these two big sticks – MCOs are prohibited by law from retaliating.

Read and understand the "State Master Contract" that governs the relationship between insurers and SNF healthcare providers. If insurers deviate from this contract, they are out of compliance and at real risk of penalties from their bosses.

"March and Talk." Chad noted that despite most MCO contracts actually being out of compliance in some fashion with the state master contract, you often have no choice but to enter into an existing single case agreement or generic contract with an MCO ("march"). Go ahead and accept the contract, deficient as it is, because now you have standing. Once you have standing, you can improve the contract ("talk") – most importantly via filing claims with DOBI and CMS.

Hire a person, VP-level, to specialize in MCO Contracting.  

We Wear the "White Hat." Remember, insurers are essentially just bill payers. In the eyes of the bill payers' bosses, DOBI and CMS, SNFs are actually on the same footing as the patients/residents – we wear the white hats, not the MCOs. We are standing up for patients to get their healthcare appropriately paid.

For more information on how sb2 can help your organization remedy bad MCO behavior, contact us at any time.