Managed Care Contracts in LTC

[CapeCodMermaid, RN]

Who in your facilities handles the Managed Care patients?....who gets the authorization to admit and who deals with the insurance company's case manager? I've had the job and got rid of it and now have it back again. I had it when I was the Medicare (PPS) coordinator and had it as the day supervisor and now have it back as the ADON. It takes HOURS sometimes just to get an answer from the insurance companies and in the meantime the Admissions Coordinator starts to freak and pages me 6 times in an hour to get an answer.

[donmomofnine]

My admissions coordinator does all that, and the recerts as well. Makes sense to me to do it that way!:)

[CapeCodMermaid, RN]

Is your admissions coordinator a nurse? I'm trying to get the business office to take over at least the authorization to admit. All I do is copy from the faxed referal to the insurance company...surely the BOM could do that.

[donmomofnine]

My admissions coordinator is a nurse. Initial contacts for general admission go to our receptionist and she sends out the applications, fields those phone calls. The admissions coordinator does the admission paperwork, including authorizations, tours potential admissions, facilitates the whole admission process. She is also the infection control nurse and our geropsych specialist. She carries a beeper for all those calls from hosp case managers and such. She also spends much time on the phone with the HMOs!