April 10, 2020

CMS Issues Fiscal Year 2021 Proposed Medicare Payment and Policy Changes

FY2021 Hospice Payment Rate Update Proposed Rule (CMS-1733-P)
FY2021 Inpatient Psychiatric Facilities (IPF) Prospective Payment System Proposed Rule (CMS-1731-P);
FY2021 Proposed Medicare Payment and Policy Changes for Skilled Nursing Facilities (CMS-1737-P)

June, 2018 - SKILLED NURSING NEW - New Skilled Nursing Payment Model Raises Medicare Advantage Questions


May 22, 2018

LeadingAge TX - Business Office ABCs & 123s to Succeed: Managed Care Complexities Made Simple

March 2018

Managed Care Master Launch - Next Generation Managed Care Case Management Software

March 6, 2018, Duluth, Ga. – Prime Care Technologies, Inc., today announced its affiliate Managed Care Group LLC and intent to offer its Managed Care MASTER case management and reimbursement app to the post-acute care market. Synthesizing data from managed care contracts, EMR systems and case management reports, the application empowers skilled nursing facilities (SNFs) to maximize managed care reimbursement.

Managed Care MASTER incorporates best practices from 18-year managed care expert, Mix Solutions, Inc., to help providers more efficiently process skilled stays. Near real-time integration with EMR systems also enables it to deliver level-of-care alerts, making it easier for providers to adhere to patient care plans.

Having spearheaded a 10+ organization, 300+ facility pilot program, Prime Care Technologies also helped shape Managed Care MASTER, offering input from providers like Welcov Healthcare, Nexion Health, and CommuniCare. An early adopter, Mission Health Communities is leveraging the app across 29 facilities in Georgia, Kansas, Tennessee, Minnesota and Wisconsin.

"I really appreciate Managed Care MASTER’s timely level-of-care alerts, so we can act on issues in real time," said Paris Girginis, RN and Vice President of Clinical Reimbursement and Compliance at Mission Health Communities.

"Operating within the confines of managed care contracts can be complex and labor-intensive," added Cheryl Field, Chief Product Officer at Prime Care Technologies. "Managed Care MASTER delivers years of expertise into the hands of case management staff, providing step-by-step, best-practice processes. The result is a significant reduction in time spent managing in-patient stays."

Added Susie Mix, CEO of Mix Solutions, "Managed Care MASTER is changing the game for post-acute care organizations, enabling them to mitigate varying contracts with ease so they can instead focus on quality patient care." She continued, "We are pleased to invest our deep expertise in managed care contract negotiation and case management systems into this application."

Mix Solutions joins Prime Care Technologies in offering Managed Care MASTER to its post-acute care clients.

January 2018 -

Provider Presentations / Client Webinars

November 7, 2017 

THCA - Houston, TX

October 26, 2017 

National Readmission Conference - Los Angeles, CA - Profiting in a Managed Care World

October 17, 2017

AHCA - Las Vegas, NV - Tips & Techniques for Managing Managed Care

August 1, 2017

FHCA (Florida) - Orlando, FL - Best Billing Practices - Sink or Swim

1. Describe case management steps actively managing a patient stay; pre-admission to discharge best practices, managed care teamwork and patients reviews

2. Business office managed care operations; comprehension of executed contracts, quick reference summaries of executed contracts and managed care team communication protocol

3.Critical billing practices; goal is a clean claim, eliminate take backs, introduction to Audit 101 and is aging bringing wisdom or just shortage of cash

June 5, 2017

Ability/Connect Conference  - New Orleans, LA - Managed Care Mysteria: The Reality of Revenue

April 27, 2017

LeadingAge IL  - Managed Care - Thriving with the New Skilled MIX - Maximizing Reimbursement

April 4, 2017

ACHCA Annual Expo - Navigating the Managed Care Seas - 7 Best Billing Practices to Financial Success

March 21-23, 2017

HCANJ (New Jersey) Symposium  -  Managed Care is Here - Survive and Thrive

The lecture will give key points of the nuts and bolts of preparing your facility and business office for Managed Care. Participants will leave with managed care best practices encompassing contracting, case management and business office management as well as shedding light on the significant financial impact a facility may face if not fully prepared for this great shift.

1. Identify key strategies and new trends arising from reform and the health plan perspective yielding a framework of focus to work with managed care

2. Reveal specific areas of importance in order to improve financial outcomes while managing managed care patient stays both skilled and long term

3. Identify case management and billing work flow and steps to succeed with managed care

4. Define the various roles in a facility that will have impact on managed care success and task responsibilities to ensure success

5. Demonstrate the positive/negative financial impact of a single patient utilizing case management and business office tools

6. Provide a clear picture of the managed care ready business office

August 24, 2016

SigmaCare - Executive Exchange Summit in Orlando, FL

9:45-10:30 A.M.: "Navigating the Managed Care Seas Sink or Swim - 7 Best Billing Practices to Financial Success"                         

                                                                                                                                                                             12:30-1:30 P.M.: "Managed Care Business Office - AR Deep Dive"

August 10, 2016

Clint Maun Summit in Omaha, NE                                                                                                                                  

8:45-10:15 A.M.: "The Newest Tips and Techniques for Managing Managed Care"                                                                                  

1:15-2:45 P.M.: "Top 10 Gold Nuggets for Achieving Managed Care Success"

July 19, 2016, 10:30 A.M. - 11:30 A.M.

​​50 Shades of Data: Strategically Leveraging Your Post-Acute Care Data
Webinar Q&A

What are some of the key differences between the administration of standard Medicare patients and Medicare or private managed care patients?

With standard Medicare patients, the post-acute care provider is in charge of the stay and the one who dictates RUG rate, how much therapy to give, when a patient is discharged, and so on. There is familiarity with the process as it has been in place for years.

With managed care patient stays, everything is kind of outside of the post-acute care provider’s hands. The provider is given an authorized level dictated by the health plan/med group and is told when the patient will leave the facility, as well as which vendors they will need to use for home health support for the patient. That’s a huge difference that can be hard to get used to.

What types of data do the SNFs who are dealing more with managed care patients need to start collecting and tracking?
The most important thing is to make sure the data in their contracts is not only accessible, but being used by everyone in the facility who manages the patient. Take note of exclusions, levels, and acuity in these contracts because it’s going to be critical in managing the patient according to the contract.

Without due diligence on the front end, a patient can coast through our facility, get clinical care, and then go home. The problem is that no one has compared the care being provided against the patient contract – and this is what costs the facility. Assigning one person to manage this process from the get-go is extremely important to getting clinical care in sync with the contract.

When a SNF works directly with an HMO case manager on a patient – what data does the HMO have and what data should the SNF case manager be prepared to provide?
The case manager really just needs a review of what is ”skilling” the patient. It should be along the same guidelines as Medicare. The data shared should reflect the patient’s skilled needs and the progress the patient is making with each need.

Developing a standard progress report form helps case managers in facilities gather the appropriate information that managed care case managers want to know.  It shows the skill required by the patient (IV administration, therapy, wound care, stage 3, stage 4, etc.) and the progress made with that ailment – the skill is very important.

It’s also important to stay timely – update forms every 3 days. If the managed care case worker wants it once a week, have that information handy and ready for them. And don’t be late.

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