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Some Strategies for Getting Case Management Funded Within Health Plans

For case management to be incorporated into a structure that will fund it, it must be recognized as an integral element in services involving treatment. This is more realistic if the States decide to offer services by use of Medicaid HMOs, which are managed. The same is also true for people who may be receiving services through Medicare HMOs. Another strategy is the control of costs during the provision of care, which enables the case managers to demonstrate the utility of case management to a managed care company that is newly engaged.

The case managers may as well provide the clients with supportive services or wraparound to prove the value of the case management. In addition, the use of managed care tools such as clinical pathways can be attractive to administrators of a program that operates in the shared-risk environment.  To ensure the comprehensive case management system and to justify the latter for funding or as a reimbursable service, the criterion within a framework of the managed care is developed. This has to be done with flexibility that is inherent and necessary resources to eventually lead to enough savings (“Chapter 6 – Funding Case Management in a Managed Care Environment,” n.d.).

Major Difference between a Service and a Reimbursement Strategy

A Reimbursement Strategy comprises of a plan that is useful in designing studies when working in the clinical research. The studies provide information for “added value” and “medical benefit” which helps in securing coverage. It also presents the data for clinical trial to the Medicare and Medicaid Services (CMS) centers for the approval of reimbursement. Additionally, reimbursement strategies identify new technologies codes such as for medical devices and also works with FDA in order to phrase the indications and intended use which can fit coding and coverage (Stark & Jaeger, 2011).

 On the other hand, the provided services involve preparing and reviewing hospitals’ Medicare Cost Reports (MCR). These reports are important since they assure the compliance and maximization of reimbursement. Through proper MCR service strategies, the clients are provided with a feedback mainly through Management Report which first reviews and then comments on all the reports’ aspects before giving suggestions and guidance for the program’s third party facility (Strategic Reimbursement – Services, n.d.).

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