Discover how Medicare Advantage initiatives are affecting providers and what can be done to overcome the operational challenges they pose. BlackTree Consulting Director Brian Harris and Consulting Manager Samantha Soulas in partnership with Beth Ann Morren of Elara Caring, will present the strategies needed to manage Medicare Advantage contracts and achieve profitability.

Key Takeaways

  • MA expansion of benefits is leading to fast growth in MA enrollment
  • Understand the operational challenges unique to MA
  • Know your worth as a provider when negotiating with MA plans
  • Be informed and negotiate accordingly
  • Providers are key to payor education


BlackTree Recommends

  • Know your market – it may differ from the global MA demographics

Revenue Cycle Solutions:

  • Create a payor matrix to document the nuances of each payor
  • Customize your EMR and clearinghouse to meet different billing requirements
  • Strategize document management and collections efforts by payor timely filing limits
  • Structure authorization assignments by payor to develop staff expertise – authorization is a top write-off reason for MA

Managing Contracts:

  • Determine your costs and negotiate rates based on desired margins
  • Negotiate favorable terms for authorization, timely filing limits, etc.
  • Demonstrate your value to the payor – social determinants of health, inpatient readmission reduction, specialty programs, etc.
  • Opt for 2-year contracts over evergreen contracts – easier to negotiate incremental rate increases
  • Be organized in contract management and reevaluate aged agreements
  • Keep your agency’s information current with the payor – ease of doing business!


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