Managed Medicare

Managed Care Organizations are quickly consuming market share in the Federal Medicare Reimbursement System.

Managed Medicare programs are referred to as Medicare Advantage Plans. These plans are designed by a private company that contracts with Medicare to provide beneficiaries with all eligible Part A and Part B benefits. There are multiple Medicare Advantage Plans including Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. When enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and will not be paid for under Original Medicare. Providers are subject to the Medicare Advantage program audits and other various types of audits helping drive the industry towards improvements in the delivery of health care services in the Medicare Advantage program. Ramifications of a poor performance under audit are significant and costly for providers.

How can Harmony Healthcare International, Inc. (HHI) help?

Harmony HealthCARE Specialists assist providers in navigating through audit preparations as well as provisions for appealing denied claims. The key elements of our services include on-site visits that focus on the following:

  • Review of specifications of Managed Medicare Contractual agreements
  • Review of current Managed Medicare interdisciplinary process
  • Managed Medicare Eligibility and Coverage Criteria
  • Managed Medicare Caseload review
  • Patient specific case management strategies
  • Facility staff education specific to Managed Medicare program management
  • Off-site access to Harmony HealthCARE Specialists between site visits
  • Comprehensive written report

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