Module 35
In this lesson, you will explore the various payer sources that exist in the skilled home health care space, starting with government programs like the VA, Medicaid, and Medicare. You will learn the specific qualifications and enrollment processes required to work with these payers. The lesson also covers Managed Care Organizations (MCOs), which manage care across diverse payer types, and commercial insurance plans, which operate independently of government subsidies.
You'll gain insights into handling pre-authorizations, which dictate how many visits you can provide and how much you’ll be reimbursed. The lesson explains the differences between Medicare’s episodic short-term coverage and Medicaid’s broader scope, which includes personal care services. It also addresses the challenges of out-of-network services and the risks of not receiving payment from private or commercial payers.
The lesson emphasizes the importance of identifying key payers in your service area, building relationships with them, and consistently expanding your network to avoid dependency on one payer source. Finally, it offers tips on managing private and self-pay clients, with a strong recommendation to collect payments upfront to avoid financial issues. Diversifying your payer mix is critical to protect your agency from economic fluctuations and changes in payer policies.
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