Mason Kaufman, Executive Director… mkaufman@meals.org 315-478-5948 ext:204 MEALS ON WHEELS OF SYRACUSE (MOWS) OUR EXPERIENCE WITH THE VBP CONTRACTING PROCESS
Disclaimer: I’m no expert and your experiences may vary. So we are on the same page: Definitions- Providers- Managed Care service providers like you Organizations (MCOs)- and me. Insurers who manage cost, utilization, and quality… they pay us
Background Meals on Wheels Association of America arranged a Business Associate Agreement with Fidelis Care in 2011 as a central point for meals programs in the U.S. MOWS began providing meals in 2013. In 2013 MOWS established a local agreement with VNA Options (Nascentia) In 2014 MOWS established a local agreement with Fidelis Care Since, MOWS has had agreements with United Health Care (now out of area), iCircle Care, VNSNY (now out of area). We submitted applications in with Aetna Better Health, Excellus Community First Choice, and Elderwood Health All of them approached us.
Initial Concerns Capacity concerns amongst meal programs… could we handle the volume of referrals? It was slow going and still is gradual. Could we handle expectations from the MCO? The mother ship’s support was comforting so we dipped our toes in the water. Besides, the money was good!
Expectations for Us from the MCOs Home delivered nutritious well-balanced meals- already doing that! Itemized invoicing record keeping- already doing that! Confidentiality and protection of client information- already doing that but, tightened our written policies somewhat. Program standards; data protection, personnel vetting, client/patient complaint policies and service satisfaction measures (survey). LEIE (List of Excluded Individuals and Entities)review. They wanted a NPI number so we gave them an NPI number along with our EIN number. They didn’t expect any reporting just an agreement for access to records if they needed to audit us. Only Nascentia did an audit once since 2013.
PROS • Higher reimbursement rates than typical • Between 12.5 and 140% more • A new funding stream means serving more people • Under age 60 with Medicaid • Relief for overtaxed funding streams CONS • Managing claims for reimbursement- CMS1500 • Managing authorizations for service • Navigating the MCO communications bureaucracy • Denied reimbursements and “overpayments”
SOME CONSIDERATIONS Consider all costs when negotiating rates and what the prevailing rate may be in your area. Make sure you have capacity to manage claims and know what each MCO expects for completing claims. It can vary! Consider costs shares to manage capacity Meals on Wheels in Texas and California are considering central points of entry for Managed Medicaid clients in their States. Consider joining a group or IPA to represent you in negotiating with MCOs Ask for a provider relations person to assist with ongoing questions or issues when providing service. Ask for free online claims submission I purchased FormDocs CMS1500 to manage printed claim submissions
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