HMO Part BSave hours with expert case management
Chasing authorizations is stressful.
You’re running a successful facility.
You’re servicing many patients.
And obtaining and tracking authorizations takes up hours of your time!
Requests need to be followed up repeatedly.
Follow-ups are lengthy and tedious.
Minor errors result in denials.
And your stack of aging claims keeps growing.
Fortunately, there is a better way to tackle these tasks.
Outsourced case management
At Case Management Solutions, we have an expert team on hand, ready to handle your caseload professionally.
We know that insurers are quick to refuse claims.
That’s their job.
At Case Management Solutions, however, we work for you.
With our focus fixed firmly on your bottom line.
With a repertoire of over 100,000 authorized days each month over the past decade, we are keenly aware of the processes and documentation required to maximize reimbursement for your facility.
We don’t just manage your caseload.
We know your rights and we pursue all relevant departments until you get maximum uninterrupted coverage for the duration of each patient’s clinician-recommended length of stay.
When you hand over the reins you get:
Higher financial gains
“Nearly 100% collections to the 20+ facilities we service together”
“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.”
With every Managed Long Term Care package, you get a personal case manager who focuses exclusively on your long-term care and custodial patients.
Your case manager will remain on-call, while ensuring:
- Every MLTC/MLTSS patient in this category is admitted with the proper authorization and benefits.
- Real-time tracking of relevant authorizations.
- Ongoing communication with the insurance case manager, so continued authorizations are obtained and matched with each patients’ level of care. This includes the submission of comprehensive clinical updates to the insurance provider.
- Communication with the billing departments to facilitate claim submission, as well as monthly pre-billing triple checks for all authorized days.
- Denial management — including tracking, response, and appeal.
- Real-time communication with the SNF’s interdisciplinary team.
- Obtainment and tracking of all coinsurance/copay days for patients who have MLTC/MLTSS as their secondary payer.
- Obtainment and tracking of all MLTC/MLTSS authorizations required for post subacute payer stays, including:
- Room and board authorizations
- Hospital bed-hold authorizations
- Therapeutic leave of absence authorizations
- Obtainment and tracking of all retroactive MLTC/MLTSS days that require authorization intervention.
Denial Management and Appeals, including internal and external appeals.
Monthly MCO Billing Reconciliation
Authorization-Related Claim Issue Resolution (old and new claims)
Contract Review and Negotiation
Taking the leap
Changing the way you deal with case management is hard.
We know how challenging it can be.
But handling it in-house is even harder (and often less profitable.)
At Case Management Solutions we love numbers.
We don’t just say we’re successful; we prove it.
Rule your facility. Know your stats.
Using proprietary software, we track every stage of the process, meticulously monitoring the progress of each patient with trend-tracking and utilization-reporting.
You’ll have data to prove our achievements in no time.
With monthly check-ins to review your data, we ensure that we’re helping you secure the maximum you can at every stage. We aren’t satisfied with the status quo and we never tire of persevering for our goal.
“CMS has more experience than any in-house case manager we could ever employ”
“Having CMS on board for several of our facilities for a number of years, we’ve found them to have more experience than any in-house case manager we could ever employ. They’ve increased our revenue in so many ways that they essentially pay for themselves.”