Managed Care Minute
December 2020 Volume 23
NEW THINGS COMING FOR YOU
We have made some recent access changes to the MCCFL Client Portal https://client.mccfl.us/public/.  Effective immediately, we are implementing individual access to the portal instead of the single log in per facility. Please email your liaison or [email protected] to initiate an individual log in. You will then receive an email from ‘[email protected]’ with the subject ‘portal access’.  The email will contain a link for you to create your own unique login credentials.  
A Message From Our President
Destiny Quinones

End of the year things to lookout for!

It is a new year which brings a round a lot of changes to everyone including our patients. Medicare open Enrollment was October 15th, 2020 to December 7th 2020. During this timeframe, Medicare eligible people have the option to switch from Traditional Medicare to a Medicare Advantage Plan, switch Medicare Advantage Plans or change their stand-alone Part D Plan. It is important to validate all of your resident’s insurance coverage, attain their deductibles, out of pockets and new copays as of January 1st, 2021. Something to remember all Medicare Advantage deductibles and out of pocket expenses reset on January 1st.
It is also important to notate the Medicare Advantage Open Enrollment Period, which runs from January 1st, 2021 to March 31st 2021. This timeframe allows a member that is enrolled in a Medicare Advantage plan to: switch to a different Medicare Advantage plan, drop their Medicare Advantage plan and return to Original Medicare, or signup for a stand-alone Part D Drug Plan (if they return to Original Medicare).

It is a best practice to run Medicare Verifications on ALL skilled members on the 1st and 15th of the month through April to catch potential changes. 
Increasing Direct Referrals while Improving Transition of Care
Increasing quality referrals is a goal of every SNF. How we go about it varies from organization to organization but if we can target our efforts and also impact our quality of care, it is a win for all parties.   There is a simple formula to do both at the same time. Engage with the Primary Care Physician (PCP) in the community.  The PCP is key to the patient’s success post discharge because they are the coordinator of all services, particularly if the patient has an HMO plan. Many PCPs are the gatekeeper of all services and some have financial stake in services rendered to a patient.  If you engage with the PCP’s office upon a patient’s admission, you can then advise them as to patient placement, ask who their referral manager is and if there is a preferred home health agency for DC planning. This is a great marketing technique that gives you a reason to call the office and place you in partnership position. Also, by passing this information forward to the rest of your internal team, it will save them time and frustration when a referral is needed and for DC planning. Example: Patient is on an HMO plan and needs to see a specialist outside the facility. The PCP will have to give the referral and likely has a preferred provider that they send their patients to; if SNF staff has the PCP information, the process can begin and will go more smoothly. When they do not have the PCP information, they can spend an enormous amount of time trying to figure it all out.  When it comes time for DC planning, engaging again with the PCP office, setting up a post DC appointment and providing them a copy of DC summary with a medication reconciliation is very valuable. Yes, we give it to home health and the patient, but more often than not, the PCP never gets a copy. Most PCP offices will appreciate this effort and when they need to send a patient for SNF services, they will remember your efforts. 

New to Medicare Advantage Plans Come 2021
For 2021, there are three major additions to the Medicare Advantage Open Enrollment Period.
  • Telehealth services – expansion of services to include more specialist and flexibilities
  • Adult day care services, In-home personal care services, allowance for over the counter products, Home safety modifications, and Meal delivery
  • ESRD – can now enroll into a Medicare Advantage plan(s)
Additional Training
Availity
Did you know that Availity has live and prerecorded webinars for training on how to use their site? Training covers from Eligibility and Benefits to Authorizations to Claims and can be found on the top tool bar called Help & Training.
Availity Learning Center - you will need login credentials to access

CareCentrix
Provider training is now being offered monthly and can be found on the CareCentrix portal here under WellCare PAC materials then Ongoing WellCare-CareCentrix PAC Trainings.
Webinar's hosted by MCCFL
December
  • End of Year To Do's: Hint and tips on how to manage your Managed Care for End of Year hosted by Destiny Quinones.
January
  • Case Management 101: Hint and tips on how to manage your Manage Care members in house host by Mary Hirsch.
Reach out to your Managed Care Liaison to get links to join webinars!
Housekeeping items...
We suggest as a best practice to re-validate all Medicare verification's on ALL skilled members on the 1st and 15th of the month to catch potential payer changes.
When employees are no longer employed by a facility, please remember to remove their access to insurance portals.  This practice will assist in keeping the facility HIPAA compliant.