Comprehensive HMO/MCO Case Management Services

Helping your facility achieve maximum reimbursement by obtaining, tracking, and managing your authorizations.

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Managing

100,000+

authorized days per month

Managed

$2 billion +

in authorizations
to date

Managing

$50 million

in authorizations
per month

Recouped

$30 million +

of delinquent/written-off HMO agings

Successful insurance case management often relies on fragmented processes involving multiple departments. This typically results in premature denials, missed revenue opportunities, and unorganized billing.

Is your facility dealing with…

Long waits to speak with an insurance case manager?

Wasting time and money in the process of obtaining the information you need.

Recurrent HMO denials?

Impacting your revenue and readmission rates, while you struggle to find an alternative payor source for your patient.

Complicated contract guidelines?

Leaving you confused about appropriate levels of care at the risk of over/under utilization of therapy minutes.

Unrealistic discharge expectations?

Forcing you to scramble for a solution to an untenable situation at the last minute.

Meet Case Management Solutions

Your outsourced case management team that provides a hassle-free solution to the challenges of HMO/MCO.

Our goal: Making managed care more manageable.

We service skilled nursing facilities (SNF), nursing homes, hospital systems, and therapy providers, integrating into your facility to manage your entire case management process.

 

With Case Management Solutions you’ll get:

Streamlined HMO Processes

Streamlined HMO Processes

Instead of a fragmanted process involving multiple departments, you’ll have one comprehensive source for all things HMO.

Enhanced IDT/ Billing Communication

Enhanced IDT/ Billing Communication

On average, more than 25% of lost revenue comes from poor billing and revenue management practices. Benefit from eagle-eyed reconciliation with our triple-check process.

Increased Staff Productivity

Increased Staff Productivity

Relieved from the headache of case management, your staff will be more focused on getting their own jobs done right, resulting in increased productivity.

Cleaner Claims

Cleaner Claims

Working closely with your billing team, we help you achieve cleaner claims, subsequently improving your cash flow through timely reimbursement.

Reduced Denials

Reduced Denials

Backed by years of experience, we operate proactively by showcasing medical necessity to the insurance case managers, justifying continued authorization.

Optimal Authorized Levels Of Care

Optimal Authorized Levels Of Care

Through careful review of each patient's clinical services, we ensure that your levels of reimbursement are in line with your contractual entitlement.

Optimal Length of Stays

Optimal Length of Stays

Following your clinician’s recommendations, we help you secure the optimal lengths of stay for each of your patients.

Increased control

Increased control

With our detailed trend tracking and utilization reporting, you'll have all your facilities' data at your fingertips, allowing you to monitor its progress with ease.

… giving you increased revenue and unparalleled peace of mind.

What leaders in the industry say about Case Management Solutions:

“Transferring our insurance processes to CMS was a no-brainer. Gone are the days of being bounced from one department to another, waiting on hold for hours, and making sense of inaccurate information. CMS is available for us around the clock and I trust their guidance implicitly, confident that I’ll be reimbursed at the end of the day.”

Tziril Yurman, Director of Admissions

The Riverside, Premier Rehabilitation & Healing Centre

“Bringing Case Management Solutions on board to ease our coordinator’s load has removed a tremendous headache from our facility and reduced operational costs. More significantly, CMS helped us achieve optimal levels of reimbursement, and authorizations are dealt with in a timely manner.”

Akiva Gonter, Finance Coordinator

Palm Gardens Nursing and Rehabilitation

“CMS deals with our insurance processes from A to Z, freeing up our employees so they can better focus on getting their individual jobs done right. When we dealt with things in-house some of our case managers could refuse to fight for a particularly difficult case, but not so CMS. We tell them what we need and they persevere until the end.” 

Moti Edelstein, Controller

Trusted by establishments of all sizes:

Are you leaving money on the table?

Work overload

Your case manager is top notch, but the workload has become too heavy to handle, leaving your facility with frequent denials and missed authorizations.

Compliance issues

Patient notes are delayed, documents aren’t submitted as required, and denials/appeals aren’t dealt with in a timely manner, resulting in administrative denials.

Missed opportunities

Due to limited understanding of insurance contract guidelines, your staff is unaware of your patients’ entitlement to higher carve outs and/or higher rates of reimbursement.

Re-hospitalizations

As a result of frequent and untimely cuts to patient stays, your facility has accrued suboptimal re-hospitalization rates.

With more than two decades of experience, we have the proficiency and tools required to help you navigate the red tape successfully to maximize your revenue.

Are you losing out due to money left on the table?

Work Overload

Your case manager is top notch, but the workload has become too heavy to handle, leaving your facility with frequent denials and missed authorizations.

Compliance Issues

Patient notes are delayed, documents aren’t submitted as required, and denials/appeals aren’t dealt with in a timely manner, resulting in administrative denials.

Missed Opportunities

Due to limited understanding of insurance contract guidelines, your staff is unaware of your patients’ entitlement to higher carve outs and/or higher rates of reimbursement.

Re-hospitalizations

As a result of frequent and untimely cuts to patient stays, your facility has accrued suboptimal re-hospitalization rates.

With more than a decade of experience, we have the proficiency and tools required to help you navigate the red tape successfully to maximize your revenue.

We did it for them; we can do it for you too.

Client:

A reputable nursing home operator contacted CMS to take over the case management of a newly acquired facility in total disarray.

Case Management Solutions cleaned up $2 million dollars of previously denied MLTC/MLTSS claims, take-backs, and retroactive authorization payments.

Earned in retro-reimbursement:

from Case Management Solutions

Client:

SNF facility with a fragmented case
management process that resulted in low levels of authorizations.

Case Management Solutions stepped in to manage their authorizations and Level 2 utilization of all HMO level days increased, with a Level 1 decrease of 60%.

Level 1 utilization of HMO level days decreased by

%

with Case Management Solutions

Client:

COO of a large SNF group transferred the case management of an additional facility to CMS as the facility’s current staff were struggling with the heavy workload.

Case Management Solutions took over the entire case management process and relieved the work of two full-time employees.

Relieved the workload of

full-time employees

with Case Management Solutions

Transferring your caseload to Case Management Solutions is hassle-free.

Review our analysis of your facility

Select the services you require

Meet with your dedicated personal team

No initial fees, no headache, no complicated process.

We were initially hesitant to use an external party, but Jeff and his team are well-known for their expertise, and they’ve been there for us every step of the way. Knowing they are in close contact with the insurance companies made us comfortable with our day-to-day operations right away. Patient stays are now more in line with clinician recommendations, and denials are far fewer. It has been a win-win for us.”

David Roll, Administrator

The Grand Pavilion for Rehab and Nursing

“CMS is super accommodating. At one time we felt that the case manager allocated to our facility wasn’t a good fit and they happily switched us over to someone else. Our case manager looks out for potential cuts, deals with time-sensitive issues, and monitors our cases on a daily basis. Having such a reputable company behind us has been very very helpful.”

Simon Fuerst, Administrator

Glengariff Rehabilitation and Healthcare Center

“CMS is truly a pleasure to work with. Their staff is experienced, knowledgeable, and responsive. They implement strong processes and by working hand in hand, they have contributed greatly to the success

of nearly 100% collections to the 20+ facilities we service together.”

Adina Tillim, Payor Tracking Manager

Comprehensive A/R Solutions