Page 139 - Business Development Orientation Binder

C. Managed Care
A health care delivery system that involves specific cost controls to provide appropriate
cost effective health care. (Medicare, Medicaid and Commercial insurance can be
managed care)

Clinician Responsibilities regarding Managed Care
 Do not place servies without first receiving authorization

Case Rate
 Managed Care Organizations pays VNSNY pre-determined dollar amount to managed
their patients for 60 day by preventing re-hospitalization and or unnecessary ER visits

D. VNSNY Charitable Care and Community Benefit Fund
 For 120+ years, VNSNY has served New Yorkers with limited incomes and no ability to
pay
 Services covered by Charitable Care include professional and paraprofessional services,
DMEs and supplies
 Who is eligible
 Patients whose income is </= to 200% of the Federal Poverty Guidelines and,
 Have no insurance, or whose insurance is inadequate to meet the cost of services to
maintain the patient safely at home
 How do you get approval for Charitable Care
 Enter Family size and monthly income on the Free Care section of Fiscal screen. The
pen based computer will indicate if the patient is eligible for charitable care
 Confer with the ICTM to get approval for equipment and/or supplies

E. No Fault/Personal Injury Protection
 Coverage for injuries resulting from an MVA
 Always get name of lawyer and claim #
 Sometimes takes weeks to receive authorization
 Need to make sure other health insurance is contracted w/ VNSNY

F. Worker’s Compensation
 Coverage for occupational illness or injuries incurred by employees on the job
 Obtain lawyer’s name and claim #
 Sometimes takes weeks to receive authorization

G. Private Pay

 Payment for non-covered services or by the uninsured, who have the resources to pay
 Refer to Partner’s in Care

Reimbursement 06-27-2017 Page 4 of 4