Making Medicare Advantage Work for Your Agency Webinar Series
Webinar Series - (1.5 CEUs per webinar, 4.5 CEUs for webinar series)
Time: 10:00 am - 11:30 am
Thursday, October 15, 2026
Part 1: Understanding the Medicare Advantage Market and Selecting the Right Plans - 1.5 CEUs
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.
Wednesday, November 11, 2026
Part 2: Contracting and Negotiation - 1.5 CEUs
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 risks.
- Compare common payment arrangements, including per visits rates, episodic payments, fee schedule,s, and value-based models.
- Prepare operational, financial, and clinical performance data for use during the payer negotiations.
- Develop negotiation strategies that connect the agency's capabilities to the health plan's cost, quality, access, and member - experience priorities.
Wednesday, December 16, 2026
Part 3: Managing Authorizations, Documentation, Denials, and Administrative Burden - 1.5 CEUs
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.
FACULTY
Melinda Gaboury, COS-C
Chief Executive Officer
Healthcare Provider Solutions, Inc.
Melinda A. Gaboury, with more than 30 years in home care, has over 22 years of executive speaking and educating experience, including extensive day-to-day interaction with home care and hospice professionals. She routinely conducts Home Care and Hospice Reimbursement Workshops and speaks at state association meetings throughout the country. Melinda has profound experience in Medicare PDGM training, billing, collections, case-mix calculations, chart reviews and due diligence. UPIC, RA, ADR & TPE appeals with all Medicare MACs have become the forefront of Melinda’s current impact on the industry. Melinda is currently serving as Chair of the NAHC/HHFMA Advisory Board and Work Group, is serves on the Home Care Association of Florida and Tennessee Association for Home Care Board of Directors. Melinda is also the author of the Home Health OASIS Guide to OASIS-E and Home Health Billing Answers, 2023.
CANCELLATIONS
No cancellations or refunds will be issued once the webinar recording and handouts are sent. Unfortunately, due to the online format of this program we are unable to offer exceptions to this policy. It is recommended that each registrant review the course content prior to submitting payment to ensure the content meets individual educational needs.
CONTINUING EDUCATION UNITS (CEUs)
Provider approved by the California Board of Registered Nursing (Provider #CEP17394) for four and half (4.5) contact hours of continuing education. Continuing Education report will be issued to attendees once attendance has been confirmed.
REGISTRATION RATES
| CAHSAH MEMBER |
NON-MEMBER* | |
|---|---|---|
|
Webinar Series
(3 Webinars)
|
$299 | $598 |
Webinar Access
You will receive a separate email with the link to join the webinar.
Sina Tate
Director of Education
state@cahsah.org