The National Association for Home Care & Hospice (NAHC), in conjunction with the Home Care & Hospice Financial Managers Association (HHFMA), has developed a survey to assess the current state of home health within Medicare Advantage (MA) plans.

We are asking home health providers that contract with MA plans to complete this survey, estimated at about 10-15 minutes. Thank you in advance for your participation.

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* 1. What percentage of your patient mix is made up of traditional Medicare patients?

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* 2. What percentage of your patient mix is made up of Medicare Advantage patients?

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* 3. What percentage of your revenue comes from traditional Medicare and Medicare Advantage?

  Traditional Medicare Medicare Advantage
None
0-20%
21-40%
41-60%
Above 60%

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* 4. What percentage of your revenue comes from Medicaid?

  Traditional Medicaid Waiver Programs Medicaid Managed Care (HMO, etc.)
0-20%
21 - 40%
41 - 60%
Above 60%

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* 5. Describe your company (check all that apply)

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* 6. The following questions relate to the top 5 Medicare Advantage plans, by visit volume, that you do business with. Please list the top 5 plans.

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* 7. What is the reimbursement method that the MA plan uses for home health services?

  PDGM PPS (as existed pre-PDGM) Per visit Other
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 8. If the plan exclusively reimburses with per visit payment, how do those visit rates compare with your Medicare LUPA rate?

  > 10% less than LUPA 6 - 10% less than LUPA 0 - 5% less than LUPA LUPA Rates 0 - 5% greater than LUPA 6 - 10% greater than LUPA > 10% greater than LUPA Not applicable
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 9. If the plan exclusively reimburses on an episode basis, what is the payment rate?

  > 10% less than PDGM/PPS 6 - 10% less than PDGM/PPS 0 - 5% less than PDGM/PPS PDGM/PPS Rates 0 - 5% greater than PDGM/PPS 6 - 10% greater than PDGM/PPS > 10% greater than PDGM/PPS Not applicable
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 10. If the plan utilizes PDGM/PPS reimbursement, what billing/claim format do you use?

  RAP and Final claim Final claim only Unknown Not applicable
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 11. What is the billing timeliness requirement for the plan?

  30 days or less Between 30 and 90 days 90 days 180 days 1 year No limit Other
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 12. What is the average number of days from claim submission to payment receipt?

  <30 days 30-45 days 46-60 days 61-90 days >90 days Unknown
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 13. What percentage of claims are paid after the first claim submission?

  <50% 50-75% 76-85% 86-95% >95% Unknown
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 14. Check the box if the plan requires the following traditional Medicare documentation.

  Physician face-to-face documentation Clinical visit documentation Other
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 15. How do you determine patient coverage/eligibility for the plans?

  3rd party vendor Website Telephone Other
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 16. Have you had eligibility determination problems/errors with the plan?

  Yes No
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 17. Does the plan require pre-authorization for services to be provided and paid?

  Yes Yes, in certain circumstances No Unknown
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 18. What is the nature of the authorization process?

  Automated (secure web-based) Fax Mail Telephone Unknown Not applicable Other
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 19. What is the average length of time for initial authorization following initial request?

  Less than an hour Between 1 and 24 hours Between 25 and 48 hours Between 3 and 5 days More than 5 days
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 20. For initial weekend authorizations:

  Provides Weekend authorizations Has delays in weekend authorizations (one full day or more)
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 21. If the plan requires a reauthorization of care periodically, at what frequency is reauthorization required?

  Every 15 days Every 30 days Every 60 days Varies based on previous authorization Other Not applicable
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 22. Does the plan permit retroactive authorizations?

  Yes No Sometimes Unknown Not applicable
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 23. For MA cases, what percentage of your organization’s requests for initial authorization are denied?

  0% Less than 5% 5-10% 11-20% Greater than 20% Unknown
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 24. For MA cases, what percentage of your organization’s requests for ongoing authorization are denied?

  0% Less than 5% 5-10% 11-20% Greater than 20% Unknown
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 25. What percentage of MA cases for whom authorization had been achieved was subsequently denied?

  0% Less than 5% 5-10% 11-20% Greater than 20% Other Unknown
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 26. What percentage of your organization’s denied (initial and ongoing) prior authorizations are overturned (where overturned means denial followed by payment being achieved) on appeal?

  0-25% 26-50% 51-75% 76-100% Unknown
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5

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* 27. Does your organization start care while prior-authorization requests are pending and under review by payers?

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* 28. Does the plan have a copay for home health services?

  Yes No Unknown
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5