Physician advisors, case managers and social workers are increasingly challenged by obstacles in obtaining authorizations for inpatients requiring post-acute care. Managed Medicare insurers have denied inpatient care citing a lack of medical necessity for several years. A more recent challenge has been obtaining authorizations for long term acute care (LTAC), acute rehabilitation and subacute rehabilitation (SAR). Since many of these insurers compensate hospitals by a DRG payment (rather than a per diem rate), they have built-in speed bumps and roadblocks to authorize these post-acute services. And these patients board in the hospital without additional compensation as this process plays out. If your healthcare organization is contracted with these insurers, you must leverage them contractually, live with this process or abandon your contract.
This RACmonitor webcast, led by Howard Stein, DO, MHA, CHCQM-PHYSADV and with R. Phillip Baker, MD, will show how to leverage Managed Medicare insurers who are denying authorizations for inpatients requiring post-acute care. You will learn how to avoid associated costs of uncompensated care while helping to avoid placing patients at additional risk by boarding them in your hospital.
Why This is Relevant:
Authorization delays and denials are important to hospitals as they increase the cost of care and are patient/family dissatisfiers. Strong appeals that are timely are essential. Managed care contracting can attempt protection from this practice in the payer contract. Ultimately, it may become part of the decision-making process in whether to remain a contracted facility or not.
During this webcast, you will…
- Gain an awareness of the challenges in obtaining authorizations for post-acute care patients;
- Understand the fundamental economics of Managed Medicare insurance plans;
- Learn about the types of patients cared for in Long Term Acute Care (LTAC), Acute Rehabilitation and Sub-acute Rehabilitation (SAR);
- Understand the risks and benefits of contracting with Managed Medicare plans; and
- Learn about the grievance process for Managed Medicare plans.
Who Should Attend:
Those individuals who will gain the most from this webcast led by Drs. Stein and Baker include physician advisors, case managers, social workers, chief operating officers, and professionals in finance, revenue cycle and managed care contracting.