Managed Care

Managed Care reimbursement is dependent on the negotiation and interpretation of Medicare Advantage Plan contracts that set policy for the provision of healthcare services, as well as billing and collections.

Having systems in place to contain costs under such contracts while providing quality care is critical to successful management of Managed Care contracts.  RUG-based reimbursement under Managed Care requires accurate scoring of the MDS assessment with the appropriate representation of the clinical condition and services rendered to the patient.

How can Harmony Healthcare International (HHI) help?

The key elements of our services include on-site visits that focus on the following:  

  • Clinical medical record review for MDS accuracy, supporting documentation, therapy documentation, nursing documentation, physician certification completion, medical necessity and other needed elements to support claim integrity and skilled stay
  • Patient-specific clinical case management strategies
  • Plan document review for consistency between Medicare Skilled Coverage Criteria, Medicare Advantage Policies, and Plan Requirements
  • Comprehensive written report
  • Monthly Medicare Clinically Anticipated Stay Analysis
  • UB-04 Coding Review
  • Access to Harmony HealthCARE Specialists
  • Monthly reporting mechanism to with follow-up tools & recommendations
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