As our organizations continue to prepare for the various changes coming to the Community Behavioral Health Medicaid system, it is imperative that you take an internal assessment to gauge your readiness for managed care.  Before your organization contracts with Medicaid Managed Care Organizations (MCOs), it must conduct an internal  assessment to determine your readiness and then from that assessment, develop a punch list of questions that need to be answered to ensure your organization is properly positioned for these upcoming changes.

This blog is dedicated to the second leg of the three legged stool of managed care readiness, your financial punch list.   Remember, if one of these legs is wobbly, then the whole stool is wobbly.

 Financial Punch List
The following questions should be part of your organization’s overall financial punch list:
  1.  Does your organization have a strong Revenue Management Cycle (RCM) process for all payer sources now (Medicaid, Medicare, Commercial, ADAMH Boards)?
  2. How often does your organization bill for services rendered?
  3. What are your service costs relative to your contracted reimbursement fees (Medicaid, Commercial)?
  4. What is your process for “working” denied and/or unpaid claims?

It is our hope that these questions will jumpstart your review process and provide food for thought as you develop your game plan to become managed care friendly.

At Pinnacle Partners, we have over thirty five years of managed care credentialing and contracting experience.  In addition, we also specialize in developing efficient revenue management cycle processes to assist behavioral health organizations in working with MCOs.
Please let us know how we can be of assistance to your organization!