Healthcare: managed care: home care agency

Licensed home care services agency

March 27, 2018

Challenge:

The client faced intense pressure due to a wide range of adverse market forces involving mandatory patient enrollment in Managed Long Term Care plans, increased costs due to wage parity and fierce competition for patients. Identifying contractual and operational barriers impeding success required a multi-faceted strategy that included:

  • Analysis of existing contract reimbursement rates
  • Exploration of alternative reimbursement methodologies through payor partnerships
  • Establishing relationships with non-contracted payors
  • Enhancement of market profile
  • Identification of new revenue streams
  • Evaluation of accounts receivable for existing payors
  • Review of compliance processes with payor policies and procedures

Solution:

Mazars assembled a team of contract negotiators with the ability to leverage relationships with decision-makers at key payors in the market. Additionally, a group of managed care professionals were deployed to review internal processes and identify opportunities to improve operational efficiencies. The Team:

  • Proposed opportunities to improve reimbursement rates and contract terms
  • Identified new market players and negotiated favorable provider agreements
  • Established relationships with key payor personnel to enhance the client profile and increase member census
  • Explored partnership opportunities, e.g. preferred zip codes and co-marketing
  • Implemented a strategy to recover revenue due to underpayments, inappropriate denials or unpaid claims
  • Recommended termination of underperforming payor agreements
  • Developed a process to maintain tight monitoring of outstanding receivables with all payors

Results:

  • Successfully negotiated increased reimbursement rates with four of the LHCSAs top five payors
  • Established an enhanced relationship with key payors and increased revenue by 14% in 15 months
  • Implemented agreements with six new payors
  • Facilitated the credentialing process to accelerate implementation of new agreements
  • Instituted procedures to increase contract compliance via staff education, minimizing denials and improving submission of timely appeals
  • Designed a strategy that successfully launched an adult day program, offering senior services to an underserved community and enhancing payor visibility