As the silver tsunami of baby boomers aging into Medicare continues, so does enrollment in Medicare Advantage (MA) plans. A staggering 10,000 people are eligible to enroll in Medicare each day. From 2008 to 2017, MA plan enrollment grew from 9.7 million to 19.6 million. This growth represents 34 percent of all Medicare beneficiaries.
With the aging population, enrollment in MA plans will only continue increasing. While this represents a distinct opportunity for many providers to be more profitable if they play their cards right, growing MA enrollment also poses challenges.
First, MA plans tend to be more transient, meaning patients may switch often, even yearly if they choose through the Open Enrollment period. Second, providers must better manage each and every patient accordingly so they can maximize plan benefits. Doing so takes more effort, but the payoff can lead to profit. Providers are also challenged with transitioning to value-based care models, but putting focus on quality and effectively aligning care coordination will pay off.
Smart providers are already preparing for explosive growth in MA enrollment. After deciding what plan participation and risk seems right for your organization, you’ll need to find and evaluate existing gaps in your workflow and develop plans and partnerships that will help you achieve desired business outcomes.
The process of managing which patients are enrolled in MA plans is one major factor in your success. Your team must properly verify which MA plans your patients are enrolled in, if they’ve recently switched plans, what’s the cost sharing responsibility, and if they have other coverage outside the MA plan or Medicare. Failure to identify eligibility and plan coverage will result in rejected claims or denials, and eventually decreased cash flow.
This is where a tool like eSolutions Multi-Payer Eligibility can drastically ease MA challenges. eSolutions’ Multi-Payer Eligibility provides secure access to multiple health plans, including MA, so you can check eligibility and benefits in real-time from a single, convenient web-based tool.
With a feature unique to Multi-Payer Eligibility, you can discover all your patients’ coverage at once with our new cascading search capabilities. In one step, you can search for coverage from multiple payers, including Medicare, Medicaid and commercial payers. The tool stops searching only once coverage is found. Imagine the time this feature could save your team!
To learn more about how eSolutions can help you take the influx of MA enrollment on with confidence, call us today at (866) 633-4726! One of our revenue cycle management experts will gladly listen to your challenges, and show you the tools to help you meet them.