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NAHC/HHFMA Medicare Advantage Survey - 2024

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.
1.In which state(s) and territories does your company provide home health care? Please list only one State or territory and complete a separate survey for each state or territory where you provide MA Plan services.
2.What percentage of your patient mix is made up of traditional Medicare patients?
3.What percentage of your patient mix is made up of Medicare Advantage patients?
4.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%
5.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%
6.Describe your company (check all that apply)
7.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.
8.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
9.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
10.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
11.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
12.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
13.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
14.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
15.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
16.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
17.Have you had eligibility determination problems/errors with the plan?
Yes
No
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5
18.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
19.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
20.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
21.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
22.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
23.Does the plan permit retroactive authorizations?
Yes
No
Sometimes
Unknown
Not applicable
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5
24.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
25.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
26.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
27.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
28.Does your organization start care while prior-authorization requests are pending and under review by payers?
29.Does the plan have a copay for home health services?
Yes
No
Unknown
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5
30.Have co-pays inhibited patients from accessing services?
31.Are there burdensome requirements beyond what is present in traditional Medicare
Yes
No
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5
32.Do any of the plans you contract with also contract with third party administrators/utilization management companies?
33.Do any of the third party administrators/utilization management companies have requirements beyond what the plan stipulates?
Yes
No
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5
34.Do any payment arrangements include reimbursement for remote patient monitoring?
35.What percentage of your case load is covered by specific performance targets in the contract? (i.e. risk based bonus, penalties, bonuses for achievement of quality or performance metrics, etc.)
36.Do any of these targets prevent you from, or allow you to, participate in a plan?
37.Do any targets give preferred status?
38.Do any of the plans with which you contract use performance measures such as star ratings in the contract process?
39.Are Medicare Advantage plans disallowing services inconsistent with the Medicare benefit?
40.How common is this disallowing occurring?
41.What reasons are given for disallowing services?
42.Can you quantify the administrative resources spent on traditional Medicare vs. MA (ratio of time spent on MA vs. traditional Medicare)
43.Compared to traditional Medicare, what innovations with MA arrangements have you experienced that you perceive as beneficial?
44.Describe any PDGM issues regarding Medicare Advantage plans.
45.As a final question, do you have any concerns about the plan that you wish to convey?
Current Progress,
0 of 45 answered