Session 2: Making Medicare Advantage Work for Your Agency: A 3 Part Series on Choosing Plans, Negotiating Contracts, and Getting Paid

November 11, 2026 9:00 AM - 10:30 AM (MST)

Description

Medicare Advantage continues to reshape the home health marketplace, creating opportunities for growth while introducing new financial, contractual, and administrative challenges. This three-part webinar series will help home health leaders make informed decisions about payer participation, evaluate and negotiate managed care contracts, and strengthen the processes that support authorization, documentation, billing, and denial prevention. Participants will learn how to assess Medicare Advantage plans using market data and agency performance measures, identify contract provisions that affect reimbursement and operations, and demonstrate their organization’s value to health plans. The series will also address the practical challenges that arise after a contract is signed, including prior authorization requirements, utilization management, documentation expectations, and payer-specific workflows. 

Registrants will receive access to all upcoming sessions and recordings for past sessions. 

Part 1:10/15: Understanding the Medicare Advantage Market and Selecting the Right Plans 

A successful Medicare Advantage strategy begins with understanding the market and choosing payer relationships carefully. This session examines the major types of Medicare Advantage plans, current enrollment trends, and the factors influencing plan participation within local markets. Participants will learn how to identify the leading payers in their service areas and evaluate each plan beyond its reimbursement rate. A structured payer scorecard will help agencies consider financial performance, administrative burden, clinical alignment, referral opportunities, and long-term strategic value. The session will also help leaders determine which payer relationships to grow, maintain, renegotiate, or reconsider. 

What You’ll Learn: 

• Distinguish among common Medicare Advantage plan types and explain how plan structure may affect provider participation. 
• Use enrollment, referral, and market data to identify priority payers within the agency’s service area. 
• Evaluate Medicare Advantage plans based on financial performance, operational burden, clinical alignment, and market value. 
• Apply a payer scorecard to categorize plans for growth, maintenance, renegotiation, or possible exit.

Part 2: 11/11: Medicare Advantage Contracting and Negotiation 

Medicare Advantage contracts can affect nearly every part of an agency’s operations, from patient access and authorization to reimbursement and termination rights. This session provides a practical review of the contract provisions home health agencies should examine before entering or renewing a payer agreement. Participants will explore payment methodologies, covered services, timely filing requirements, utilization management provisions, credentialing requirements, and termination language. The session will also address negotiation strategies that position the agency as a valuable partner. Attendees will learn how to use clinical outcomes, access measures, referral relationships, and cost-of-care data to support requests for improved rates, administrative simplification, high-acuity carve-outs, and other favorable terms. 

What You’ll Learn: 

• Identify contract provisions that affect reimbursement, patient access, administrative workload, and financial risk. 
• Compare common payment arrangements, including per-visit rates, episodic payments, fee schedules, and value-based models. 
• Prepare operational, financial, and clinical performance data for use during payer negotiations. 
• Develop negotiation strategies that connect the agency’s capabilities to the health plan’s cost, quality, access, and member-experience priorities.

Part 3: 12/16: Managing Authorizations, Documentation, Denials, and Administrative Burden 

Signing a managed care contract represents only the beginning of the payer relationship. Agencies must establish reliable processes for verifying benefits, obtaining authorizations, documenting skilled care, submitting claims, and responding to denials. Weaknesses in any of these areas can delay care, increase staff workload, and reduce the value of the contract. This session focuses on the operational practices needed to manage Medicare Advantage patients effectively. Participants will examine common authorization and denial risks, payer documentation expectations, discipline-specific documentation concerns, and frequent administrative missteps. The session will also present strategies for monitoring payer performance, preventing avoidable denials, and improving coordination among intake, clinical, authorization, billing, and leadership teams. 

What You’ll Learn: 

• Identify common authorization, documentation, billing, and eligibility errors that contribute to claim denials and payment delays. 
• Establish workflows for benefit verification, authorization tracking, clinical-document submission, pre-bill review, and denial follow-up. 
• Use payer-specific performance data to identify operational problems and support corrective action or contract renegotiation.