Subacute HMOStay one step ahead with expert case management
Case management is stressful.
You’re running a facility.
You’re admitting new patients regularly.
You’re working hard to provide the best patient care while still earning a profit — and obtaining authorizations and monitoring each case is hard work!
Insurance guidelines are complicated.
Claims are denied.
Patient stays are cut short.
And staff regularly feel stretched to their limits.
Fortunately, there is a better way.
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
“Help decrease the workload… while increasing the number of insurance approvals”
“As therapy providers obtaining authorizations can be a logistical nightmare. CMS was a lifesaver and helped decrease the workload on our administrative team while increasing the number of insurance approvals. Overall, I’d highly recommend their team to any organization.”
With every Subacute HMO package, you get a personal case manager who focuses exclusively on your short-term patients.
Your case manager will remain on-call, while ensuring:
- Every HMO 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.
- HMO Notice of Medicare Non-Coverage (NOMNC) and other HMO denial coordination.
- 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.
- Participation in the SNF’s utilization review meetings.
- Real-time communication with the SNF’s interdisciplinary team.
Real-Time Authorizations & Tracking
Part B Authorizations
Contract Carve-Out Authorizations for High-Cost Medications
Denial Management and Appeals, including QIO Appeals (Livanta/Kepro), internal appeals 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.
“They constantly amaze us with their can-do attitude”
“They constantly amaze us with their can-do attitude and have successfully obtained authorizations at the highest level of care. Thanks to their professional communication skills which is what keeps our collection process smooth and super successful”