Posted by Behavioral Health Billing Solutions, LLC.
New Contingency payment options available from CareSource and Molina.
DEADLINE for the revised Contingency plans offered by both of these plans is Monday, July 16th, 2018.
As most providers know, MCO’s have a current contingency plan offered for 54% of 2016 revenue for agencies wishing to participate. There has been a lot of work going on behind the scenes to increase the percentage and improve the re-payment terms.
Word came out today from Dave Turner, CEO of the Counseling Source, that two MCO’s have made the right decision to improve their offerings in order to make the changes of the MCO carve in more sustainable for agencies. Below are descriptions of the options available through both CareSource and Molina.
However, it’s critical to note that these options expire tomorrow.
Notice Date: June 29, 2018
To: Ohio Health Partners
From: CareSource®
Subject: Advanced Payment Option for Behavioral Health Providers
CareSource has developed an alternative contingency plan to assist community behavioral health provider agencies that need more resources to transition to managed care billing through behavioral health integration starting July 1, 2018. The alternative plan will allow providers to receive additional funding (80%) as well as more time to repay the advance. However, it is important to note that under this option, reimbursement for claims submitted between July 2018 – December 2018 will be applied toward the advance payment balance. Providers have the opportunity to choose between the current ODM advanced payment model of 54.6% or the CareSource enhanced advancepayment model of 80%.
COMPARISON OF 54.6% vs 80% ADVANCE PAYMENT OPTIONS
Advance Amount |
54.6% |
80% |
|
Claims Paid inaddition to the Advance |
Yes |
No |
Deadline to RepayOverpayments |
June 30, 2019 |
December 31, 2019 |
Providers that choose to participate in this alternative option will be eligible for 80% advanced payment under the following conditions:
The provider must return a signed copy of the ODM Agreement for the Advance of Payment in PDF format by 5:00 p.m. on Monday, July 16, 2018, to BHnroll@medicaid.ohio.gov and to CareSource at OhioContracting@caresource.com.
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Once providers have submitted the ODM Agreement for the Advance of Payment, CareSource will contact each provider to discuss the details. At that time, a second agreement will need to be executed which will supersede the original ODM agreement. Both agreements are required to receive the enhanced 80% advance payment. The first agreement is to ensure that CareSource receives the ODM data analysis.
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The advanced payment from CareSource will be 80% of a provider’s average CY16 monthly reimbursement apportioned for CareSource’s member enrollment, based on ODM’s data analysis.
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Upon execution of the agreements, CareSource will advance its share of the provider’s monthly payment each month from July 2018 through December 2018, which allows providers an additional two months to receive advanced monthly payments.
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As providers begin to submit claims to CareSource after July 1, 2018, reimbursement due to the provider will be applied toward the advanced payment balance. Providers will receive a zero paid encounter and remittance advice to ensure providers remain current with their billing reconciliation. When the 80% advanced payment is paid in full, claims will be processed and paid following normal claims payment procedures. It is very important for providers to submit claims so that Q1 2019 reconciliation properly accounts for actual billings from July 1 – December 31, 2018.
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CareSource will reconcile payments from the advance period in Q1 2019. CareSource will recover any overpayments in equal monthly installments from April 1, 2019 through December 31, 2019. This will allow providers nine (9) months to repay the advance payment. In the event there is a balance due at the end of 2019, CareSource will perform a final financial reconciliation of all advance payments and claims submitted by the provider on or about January 2020. Provider will remit a refund of any advance payment amount still owed to CareSource within thirty (30) days.
EXAMPLE:
Here’s an example of how the enhanced advance payment would work:
Assume a provider has average billings of $1000 per month (per the ODM).
CareSource will advance 80% of that amount ($800) each month for 6 months, totaling $4800. If at the end of the six-month period the provider has billed less than $4800, then we will develop a repayment schedule.
Assume the provider billed $3000, then the difference of $1800 ($4800 – $3000 = $1800) would be repaid in equal installments of $200 ($1800 ÷ 9 = $200) over nine months starting April 2019 and ending December 2019.
However, if the provider bills more than $4800 during the six-month period, all claims after reaching $4800 will be processed and paid following normal claims payment procedures.
We look forward to working with Ohio’s behavioral health provider community and hope you find these enhancements helpful. Feel free to work with your health partner representative or email OhioContracting@caresource.com if you have additional questions. Application available here.
Molina’s option and the details are available here. The document that needs completed is available here. Both are due to be completed tomorrow by 5:00 pm.
Special thanks to the team that has been working diligently to get the MCO’s to agree to a more appropriate contingency payment plan that meets the needs of behavioral health providers currently going through this challenging change.