MEALS ON WHEELS OF SYRACUSE (MOWS) OUR EXPERIENCE WITH THE VBP - - PowerPoint PPT Presentation

MEALS ON WHEELS OF SYRACUSE (MOWS)

OUR EXPERIENCE WITH THE VBP CONTRACTING PROCESS

Mason Kaufman, Executive Director… mkaufman@meals.org 315-478-5948 ext:204

Disclaimer: I’m no expert and your experiences may vary.

• So we are on the

same page:

Definitions-

• Managed Care

Organizations (MCOs)- Insurers who manage cost, utilization, and quality… they pay us

• Providers-

service providers like you and me.

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

• nce 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