F.O.R.C.E. Healthcare Resources, LLC (Founded on Regulatory Compliance and Ethics) HMO Do’s and Don’ts September 5,2012 1

About F.O.R.C.E.? Home Health Consulting Firm – Founded 2005 Services Provided: 1.Home Health Billing Seminars & Training (J.V. w/ Medicare Training & Consulting) 2.Home Health Outsource Billing 3.Home Health Outsource Medical Coding 4.Home Health Billing Clean-up Projects 5.Home Health Operation / Process Consulting 6.Home Health Financial Consulting 7.Home Health CLIA Billing & Recovery Project 2

Contact Information F.O.R.C.E Healthcare Resource, LLC. –Website: Terri Ready, COO -Direct: ext Mobile: Lynn Alley, Billing Supervisor –Direct: Jonathan Sellers, Sales & Marketing - Direct:

Background Enacted in 1997 Medicare Part C Types of Medicare Advantage Plans –Health Maintenance Organization(HMO) –Point of Service(POS) –Preferred Provider Organization(PPO) –Private Fee for Service(PFFS) Reimbursement Episodic or Per Visit 4

Don’t be afraid to provide care to patients with Medicare Advantage Plans Don’t treat HMO’s/Advantage Plans like traditional Medicare Don’t assume you know how to handle it! 5 HMO DO’s

HMO Do’s Do check complete home health benefits (not just SOC Do check if agency is in network Do see if out of network benefits are available Do obtain authorization if required 6

HMO Do’s Do recheck complete benefits at the beginning of each calendar year Do establish with HMO if billing is per episode or per visit (currently plans changing!) Do document verifications and provide patient with data during SOC visit and have patient verify and authorize care Ask if F2F required 7

Do research as to what plans are active in your area Do make referral sources aware that you are “in network” with providers Do sign up for internet based management of HMO’s if possible 8 HMO’S

HMO News Effective June 6, 2011 Medicare HMO, PPO or other plans Agency out of network If unaware of Medicare replacement status or mid-episode change and have documentation of this (HIQA), agency entitled to full episode from HMO Co-pays may still be required 9

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