Making Medicare Advantage Work for Your Agency: A 3 Part Series on Choosing Plans, Negotiating Contracts, and Getting Paid
Medicare Advantage continues to reshape the home health marketplace, creating opportunities for growth while introducing new financial, contractual, and administrative challenges. This three-part webinar series will help home health leaders make informed decisions about payer participation, evaluate and negotiate managed care contracts, and strengthen the processes that support authorization, documentation, billing, and denial prevention.
Participants will learn how to assess Medicare Advantage plans using market data and agency performance measures, identify contract provisions that affect reimbursement and operations, and demonstrate their organization’s value to health plans. The series will also address the practical challenges that arise after a contract is signed, including prior authorization requirements, utilization management, documentation expectations, and payer-specific workflows.
10/15: Understanding the Medicare Advantage Market and Selecting the Right Plans
A successful Medicare Advantage strategy begins with understanding the market and choosing payer relationships carefully. This session examines the major types of Medicare Advantage plans, current enrollment trends, and the factors influencing plan participation within local markets.
Participants will learn how to identify the leading payers in their service areas and evaluate each plan beyond its reimbursement rate. A structured payer scorecard will help agencies consider financial performance, administrative burden, clinical alignment, referral opportunities, and long-term strategic value. The session will also help leaders determine which payer relationships to grow, maintain, renegotiate, or reconsider.
What You’ll Learn:
- Distinguish among common Medicare Advantage plan types and explain how plan structure may affect provider participation.
- Use enrollment, referral, and market data to identify priority payers within the agency’s service area.
- Evaluate Medicare Advantage plans based on financial performance, operational burden, clinical alignment, and market value.
- Apply a payer scorecard to categorize plans for growth, maintenance, renegotiation, or possible exit.
11/11: Medicare Advantage Contracting and Negotiation
Medicare Advantage contracts can affect nearly every part of an agency’s operations, from patient access and authorization to reimbursement and termination rights. This session provides a practical review of the contract provisions home health agencies should examine before entering or renewing a payer agreement.
Participants will explore payment methodologies, covered services, timely filing requirements, utilization management provisions, credentialing requirements, and termination language. The session will also address negotiation strategies that position the agency as a valuable partner.
Attendees will learn how to use clinical outcomes, access measures, referral relationships, and cost-of-care data to support requests for improved rates, administrative simplification, high-acuity carve-outs, and other favorable terms.
What You’ll Learn:
- Identify contract provisions that affect reimbursement, patient access, administrative workload, and financial risk.
- Compare common payment arrangements, including per-visit rates, episodic payments, fee schedules, and value-based models.
- Prepare operational, financial, and clinical performance data for use during payer negotiations.
- Develop negotiation strategies that connect the agency’s capabilities to the health plan’s cost, quality, access, and member-experience priorities.
12/16: Managing Authorizations, Documentation, Denials, and Administrative Burden
Signing a managed care contract represents only the beginning of the payer relationship. Agencies must establish reliable processes for verifying benefits, obtaining authorizations, documenting skilled care, submitting claims, and responding to denials. Weaknesses in any of these areas can delay care, increase staff workload, and reduce the value of the contract.
This session focuses on the operational practices needed to manage Medicare Advantage patients effectively. Participants will examine common authorization and denial risks, payer documentation expectations, discipline-specific documentation concerns, and frequent administrative missteps.
The session will also present strategies for monitoring payer performance, preventing avoidable denials, and improving coordination among intake, clinical, authorization, billing, and leadership teams.
What You’ll Learn:
- Identify common authorization, documentation, billing, and eligibility errors that contribute to claim denials and payment delays.
- Establish workflows for benefit verification, authorization tracking, clinical-document submission, pre-bill review, and denial follow-up.
- Use payer-specific performance data to identify operational problems and support corrective action or contract renegotiation.
Faculty
Melinda Gaboury, CEO, Healthcare Provider Solutions
Melinda A. Gaboury, with more than 35 years in home care, has over 24 years of executive speaking and educating experience, including extensive day-to-day interaction with home care and hospice professionals. She routinely conducts Home Care and Hospice Reimbursement Workshops and speaks at state association meetings throughout the country. Melinda has profound experience in Medicare PDGM training, billing, collections, case-mix calculations, chart reviews and due diligence. Medicare Review appeals with all Medicare MACs have become the forefront of Melinda’s current impact on the industry. Melinda is currently Chair of The Alliance/HHFMA Advisory Board and Work Group, serves on the Home Care Association of Florida Board of Directors, and the Tennessee Association for Home Care Board of Directors. Melinda is also the author of the Home Health OASIS Guide to OASIS-E2 and Home Health Billing Answers, 2025.
Regina Wild, Director of Managed Care Consulting, Healthcare Provider Solutions
Regina Wild is currently Director of Managed Care Consulting with Healthcare Provider Solutions. Regina is an experienced healthcare professional with over 15 years of industry experience. She has worked as a nurse, business development professional, and contracting/credentialing specialist. Regina has a deep understanding of the healthcare system and has worked in various healthcare settings, gaining valuable insights into the industry. Regina’s primary focus is on Managed Care contracting, where she helps providers maximize reimbursement, strengthen referral relationships, and expand their market presence. She is passionate about assisting healthcare providers in navigating the complexities of the industry and achieving their goals. In addition to her work in the healthcare industry, Regina is actively involved in several healthcare associations. She serves on education and reimbursement committees and is a sought-after speaker at conferences. Regina’s expertise and dedication to the field make her an asset to any healthcare organization.
