Question 1

Do Medicare Advantage (MA) plans pay like Traditional Medicare (FFS)?

Accepted Answer

Yes and no. By law, MA plans must cover everything Medicare covers. However, they use different billing, authorization, and payment systems. With proper coding, clean claims, and appeals, providers can receive comparable or even faster payment once processes are streamlined.

Question 2

What is the reimbursement turnaround time with MA plans?

Accepted Answer

Typical turnaround: 15–30 days, depending on the plan and claim type. Traditional Medicare is often faster (14 days). MAC’s expertise in clean claim submission and denial management ensures quicker, predictable payments.

Question 3

Do we need to be in-network with an MA plan to get paid?

Accepted Answer

Not always. Out-of-network providers can still get paid for medically necessary services, especially with clean claims and proper appeals. MAC specializes in obtaining single-case agreements, authorizations, and medical necessity approvals for out-of-network agencies.

Question 4

Do we need to be fully contracted with each plan?

Accepted Answer

Contracts are beneficial but not required to serve MA patients. MAC helps agencies grow census without waiting on lengthy contracting by leveraging medical necessity appeals, securing single-case agreements, and building interim solutions while contracting is in process.

Question 5

Why is refusing MA patients considered 'clinical discrimination'?

Accepted Answer

Seniors who switch from FFS to MA are still entitled to the same level of care. Refusing MA patients denies seniors access to medically necessary care, shrinks your agency’s census, and blocks growth opportunities in the fastest-growing segment of Medicare.

Question 6

Do MA plan services require authorization?

Accepted Answer

Yes, most high-cost or specialized services require prior authorization (unlike FFS Medicare). But authorizations can be streamlined with the right process. MAC provides templates, pre-submission checklists, and regulatory citations to reduce denials.

Question 7

How does MAC help us grow census with MA patients?

Accepted Answer

MAC provides automated coding and clean claim tools, appeals management and unfair payment pattern escalation, direct payor relationships with IPAs/MSOs, and gap closure projects that plans must fund through their capitation.

Question 8

What’s the benefit of partnering with MAC instead of handling billing in-house?

Accepted Answer

Faster payment cycles, denial overturns that recover lost revenue, regulatory and compliance protection, and increased patient census by accepting MA patients with confidence.

Question 9

How do MA plans affect agency scaling potential?

Accepted Answer

MA is the fastest-growing senior coverage type. FFS is shrinking every year. Agencies that embrace MA patients expand rapidly, while those that avoid MA are limiting their growth potential and leaving revenue on the table.

Question 10

Can MAC negotiate directly with IPAs/MSOs on our behalf?

Accepted Answer

Yes. MAC builds solution-based partnerships with health plans, IPAs, and MSOs—demonstrating how agencies help close care gaps, reduce CMS risk, and increase Star Ratings. This advocacy secures favorable agreements and stronger partnerships for agency owners.

FAQ