Case management reimbursement is a critical aspect of healthcare reimbursement that ensures that case managers are compensated for their services. Understanding the intricate details of case manager reimbursement is essential for both healthcare providers and case managers to ensure proper billing and payment. This article will delve into the complexities of case manager reimbursement, exploring the different types of reimbursement models, applicable insurance regulations, and key considerations for successful billing.
The reimbursement mechanisms for case management services vary depending on the healthcare setting and the specific services provided. However, the most common reimbursement models include fee-for-service, capitation, and bundled payments. Fee-for-service involves billing a specific fee for each service rendered, while capitation entails a fixed payment for a predetermined number of services. Bundled payments combine reimbursement for case management services with other related services, such as medical care or rehabilitation.
Insurance plays a pivotal role in case manager reimbursement, and understanding the nuances of insurance coverage is crucial. Insurance policies typically specify the types of case management services that are covered, the frequency of reimbursement, and the required documentation. Case managers must familiarize themselves with the insurance policies of the clients they serve to ensure that their services are eligible for reimbursement. Additionally, obtaining pre-authorization for case management services can help avoid potential reimbursement denials.
Understanding Case Management Reimbursement
Case management plays a crucial role in healthcare, helping individuals navigate complex health systems, coordinate care, and achieve better health outcomes. Reimbursement for case management services is essential to ensure the sustainability and effectiveness of this vital service.
Reimbursement for case management varies across healthcare settings and insurers. It is typically based on the type of services provided, the time spent on these services, and the patient’s health needs. Understanding the intricacies of case management reimbursement is crucial for practitioners and providers to ensure accurate and timely payment for their services.
Insurance Coverage for Case Management Services
Most major health insurance plans provide coverage for case management services. However, coverage can vary depending on the type of plan and the specific services being provided. It is essential to check with the patient’s insurance plan to determine the level of coverage for case management services. Typically, insurance plans cover services that are:
- Medically necessary
- Provided by a licensed or certified case manager
- Documented in the patient’s medical record
- Ordered by a healthcare provider
Insurance coverage may also differ based on the setting in which case management services are provided. For example, case management services provided in a hospital setting may be covered differently than those provided in a clinic or outpatient setting.
Medicare Coverage for Case Management Services
Medicare provides coverage for case management services through various programs, including:
| Program | Type of Coverage |
|---|---|
| Medicare Part A (Hospital Insurance) | Case management services provided during an inpatient hospital stay |
| Medicare Part B (Medical Insurance) | Case management services provided in physician offices, outpatient clinics, and other healthcare settings |
| Medicare Advantage (Part C) | Case management services may be included in Medicare Advantage plans offered by private insurance companies |
Medicare reimbursement for case management services is typically based on a fee-for-service model, where providers are paid a specific amount for each service they provide. Reimbursement rates vary depending on the type of service, the patient’s diagnosis, and the healthcare setting.
Understanding the Insurance Landscape for Case Management
Insurance Coverage for Case Management
The coverage of case management services by insurance varies depending on the type of insurance policy and the specific provisions of the plan. Some types of insurance that may cover case management include:
- Health insurance: Many health insurance plans provide coverage for case management services, particularly in the context of chronic conditions or complex medical needs.
- Disability insurance: Disability insurance plans may cover case management services to support individuals with disabilities in managing their daily lives and accessing necessary resources.
- Workers’ compensation insurance: Workers’ compensation insurance programs may cover case management services for employees who have sustained work-related injuries or illnesses.
- Medicare and Medicaid: Medicare and Medicaid programs offer coverage for case management services in certain circumstances, such as when the individual has a complex medical condition or requires assistance in coordinating care.
Reimbursement Rates for Case Managers
The reimbursement rates for case managers vary widely depending on a number of factors, including:
- Type of insurance: The type of insurance coverage, such as health insurance, disability insurance, or workers’ compensation insurance, can impact the reimbursement rates.
- Geographic location: The reimbursement rates for case managers can vary between different regions of the country or even between different cities within the same region.
- Expertise and experience: Case managers with higher levels of education, training, and experience may command higher reimbursement rates.
- Billing method: Different billing methods, such as per-hour or monthly retainer, can affect the reimbursement rates.
- Negotiation: The reimbursement rates for case managers can also be subject to negotiation between the case manager and the insurance company.
The table below provides a general overview of the average reimbursement rates for case managers in different regions of the United States:
| Region | Average Hourly Rate |
|---|---|
| Northeast | $50-$75 |
| Midwest | $40-$60 |
| South | $35-$55 |
| West | $60-$80 |
Billing and Documentation Requirements
To ensure timely and accurate reimbursement, case managers must adhere to specific billing and documentation requirements established by insurance companies. These requirements may include:
- Detailed documentation: Case managers must provide detailed documentation of the services provided, including the dates of service, the specific tasks performed, and the duration of the session.
- Proper coding: Case managers must use the appropriate billing codes to reflect the nature of the services provided.
- Timely billing: Case managers must submit bills to insurance companies within a specified time frame to ensure payment.
- Medical necessity: Case managers must provide evidence of medical necessity to support the need for the case management services.
- Collaboration with other providers: Case managers must work closely with other healthcare professionals and providers to ensure that the services provided are coordinated and meet the needs of the individual.
Medicaid and Case Management Reimbursement
Medicaid is a health insurance program for low-income individuals and families. It is funded jointly by the federal government and individual states. Medicaid provides coverage for a variety of health care services, including case management.
Who is eligible for Medicaid case management?
To be eligible for Medicaid case management, you must meet the following criteria:
- Be enrolled in Medicaid.
- Have a physical or mental health condition that requires case management services.
- Be unable to manage your own care without assistance.
What services are covered by Medicaid case management?
Medicaid case management services can include:
- Assessment of needs
- Development of a care plan
- Coordination of care services
- Monitoring of progress
- Advocacy for the client
How much does Medicaid pay for case management?
The amount that Medicaid pays for case management varies by state. However, the federal government sets a minimum reimbursement rate for case management services. This rate is $75 per hour.
How do I get Medicaid case management services?
To get Medicaid case management services, you must first be enrolled in Medicaid. You can apply for Medicaid through your state’s Medicaid agency. Once you are enrolled in Medicaid, you can contact your local Medicaid office to find a case manager.
Other Insurance Information
In addition to Medicaid, there are a number of other insurance programs that may cover case management services. These programs include Medicare, private health insurance, and employer-sponsored health insurance.
Medicare is a health insurance program for people who are 65 years of age or older, or who have certain disabilities. Medicare Part A covers hospital care, while Medicare Part B covers medical expenses such as doctor visits and outpatient care. Medicare does not have a specific benefit for case management services, but it may cover case management services that are provided as part of a Medicare-covered service, such as a hospital stay or outpatient visit.
Private health insurance plans may cover case management services, depending on the terms of the plan. You should check with your insurance provider to see if your plan covers case management services.
Employer-sponsored health insurance plans may also cover case management services, depending on the terms of the plan. You should check with your employer to see if your plan covers case management services.
If you are unable to get case management services through Medicaid or other insurance programs, you may be able to pay for case management services out of pocket. The cost of case management services varies depending on the provider and the services provided. However, you can expect to pay between $50 and $150 per hour for case management services.
| Insurance Program | Coverage for Case Management Services |
|---|---|
| Medicaid | Yes |
| Medicare | May cover case management services that are provided as part of a Medicare-covered service |
| Private health insurance | May cover case management services, depending on the terms of the plan |
| Employer-sponsored health insurance | May cover case management services, depending on the terms of the plan |
Strategies for Negotiating Reimbursement Rates
Negotiating reimbursement rates can be a challenging but essential aspect of case management. By understanding your value, preparing thoroughly, and utilizing effective negotiation strategies, you can secure fair and equitable compensation for your services.
1. Determine Your Value
Assess your skills, experience, certifications, and the complexity of your caseload to determine your worth. Research industry benchmarks and consult with other case managers to gain insights into competitive rates.
2. Research Insurance Reimbursement Guidelines
Familiarize yourself with the specific reimbursement policies of the insurance companies you work with. Analyze their fee schedules, coding requirements, and any limitations or exclusions.
3. Prepare a Proposal
Develop a comprehensive proposal outlining your services, estimated time commitment, and proposed reimbursement rates. Clearly justify your request based on your value and the benefits you provide.
4. Establish a Starting Point
Set a realistic target rate that aligns with your value and the insurance company’s guidelines. Be prepared to negotiate and compromise within a reasonable range.
5. Practice Your Negotiation Skills
Role-play negotiation scenarios to enhance your confidence and communication skills. Practice presenting your proposal, countering objections, and finding mutually acceptable solutions.
6. Build a Positive Rapport
Establish a cordial and respectful relationship with the insurance company representative you negotiate with. Focus on developing a mutually beneficial agreement rather than an adversarial approach.
7. Be Prepared to Negotiate
Expect negotiations to involve give and take. Be willing to compromise on certain aspects while standing firm on key principles. Consider offering alternative solutions or value-added services to enhance your proposal.
8. Document the Agreement
Once an agreement is reached, document all the details in writing. Ensure that the reimbursement rates, terms of payment, and any other relevant information are clearly outlined.
9. Track and Monitor Results
Keep track of your reimbursement rates and compare them to your expectations and industry benchmarks. This will allow you to identify any discrepancies and make adjustments as needed.
10. Maintain a Professional Demeanor
Throughout the negotiation process, maintain a professional and respectful demeanor. Avoid being confrontational or argumentative. Instead, focus on presenting your case clearly and persuasively.
11. Seek Support and Resources
If necessary, consider seeking support from professional associations, consultants, or other case managers. They can provide valuable insights, negotiation tips, and industry best practices.
| Role | Responsibilities |
|---|---|
| Case Manager |
|
| Insurance Company Representative |
|
The Role of Medical Necessity in Case Management Reimbursement
Medical necessity plays a critical role in determining the reimbursement of case management services. In general, insurance companies will only cover services that are deemed medically necessary, meaning they must be reasonable and necessary for the diagnosis or treatment of a covered medical condition.
1. Definition of Medical Necessity
Medical necessity is typically defined as a service or treatment that is:
- Medically appropriate for the patient’s condition
- Not experimental or investigational
- Reasonable and necessary to improve or maintain the patient’s health
- Provided by a qualified provider within the scope of their practice
2. Documentation of Medical Necessity
To ensure reimbursement, case managers must provide clear and accurate documentation demonstrating the medical necessity of the services provided. This documentation should include:
- A detailed description of the patient’s condition and symptoms
- Medical records and other supporting documentation
- A rationale explaining how the case management services will improve or maintain the patient’s health
- Goals and objectives for the case management services
3. Relationship to Case Management Plan
The medical necessity of case management services should be closely aligned with the patient’s individualized case management plan. The plan should outline the goals, objectives, and interventions that are deemed medically necessary to address the patient’s specific needs.
4. Denials of Reimbursement
Insurance companies may deny reimbursement for case management services if they determine that the services are not medically necessary. Common reasons for denials include:
- Lack of documentation supporting the medical necessity of the services
- Services provided outside the scope of the case management plan
- Services that are experimental or investigational
- Services that are not provided by a qualified provider
5. Appeals of Denied Claims
Case managers can appeal insurance company denials by providing additional documentation or submitting an appeal letter that addresses the reasons for the denial. Appeals should be submitted promptly, and it is often helpful to seek the assistance of a healthcare attorney or advocate.
6. Insurance Coverage for Case Management
The specific coverage for case management services varies among insurance companies. Some companies may have specific case management policies or guidelines, while others may consider case management as part of other covered benefits, such as behavioral health or chronic care management.
7. Importance of Prior Authorization
Many insurance companies require prior authorization for case management services. This means obtaining approval from the insurance company before providing the services to ensure they will be covered.
8. Bundling of Case Management Services
Some insurance companies may bundle case management services with other related services, such as care coordination or disease management. This can impact the reimbursement for individual case management services.
9. Coding for Case Management Services
Case managers must use the correct medical codes when billing for their services. The most common code for case management is H0330, but other codes may be used depending on the specific services provided.
10. Impact of Fee Schedules
Insurance companies often establish fee schedules that determine the reimbursement rates for case management services. These fee schedules can vary depending on the insurer, location, and type of service provided.
11. Importance of Compliance and Documentation
Case managers must adhere to all applicable federal and state regulations when providing case management services. This includes maintaining accurate documentation and ensuring that all services are medically necessary. Failure to comply with these regulations can result in penalties or even loss of licensure.
Fee Schedules and Reimbursement for Case Management
Overview
Case management reimbursement varies depending on the setting, payer, and insurance policy. Knowledge of fee schedules and reimbursement rates is essential for case managers to ensure they receive fair compensation for their services.
Fee Schedules
Fee schedules are predetermined rates that insurance companies or government programs pay for specific services. Case management fees can be based on a per-hour, per-case, or bundled rate.
Reimbursement for Case Management
Reimbursement for case management services typically covers the following components:
- Assessment and planning
- Coordination of services
- Monitoring and evaluation
- Documentation
- Communication with clients and stakeholders
Private Insurance
Private insurance companies have their own fee schedules and reimbursement policies for case management services. Case managers should familiarize themselves with the policies of the insurance companies they work with.
Government Programs
Government programs such as Medicare and Medicaid have specific fee schedules for case management services. These schedules are typically updated annually.
Medicare
Medicare Part A covers case management services for beneficiaries with home health care. Medicare Part B covers case management services for beneficiaries with certain chronic conditions.
Medicaid
Medicaid coverage for case management services varies by state. Case managers should contact their local Medicaid office for specific reimbursement rates.
Managed Care Organizations
Managed care organizations (MCOs) contract with insurance companies to provide health care services to members. MCOs typically have their own fee schedules for case management services.
Negotiating Reimbursement Rates
Case managers may be able to negotiate reimbursement rates with insurance companies or government programs. When negotiating, it is important to consider the following factors:
- Industry standards
- Experience and qualifications
- Case complexity
- Supply and demand
Documentation for Reimbursement
Proper documentation is essential for obtaining reimbursement for case management services. Documentation should include the following information:
- Client information
- Assessment and plan of care
- Services provided
- Date and time of services
- Signature of case manager
Billing for Case Management Services
Case managers should bill for services in accordance with the fee schedule and reimbursement policies of the insurance company or government program. Billing should be submitted timely and accurately.
Appeals
If a claim for reimbursement is denied, the case manager may file an appeal. The appeal process typically involves submitting additional documentation or evidence to support the claim.
Insurance Information
Coverage for Case Management
Case management services may be covered by health insurance, disability insurance, or workers’ compensation insurance. Coverage varies depending on the policy and the reason for case management.
Authorization for Services
Many insurance companies require authorization for case management services before they will cover them. Authorization is typically obtained by the client’s primary care physician or other authorized healthcare provider.
Duration of Coverage
The duration of coverage for case management services is determined by the insurance policy. Some policies may have a lifetime maximum for coverage.
Coordination of Benefits
If a client has multiple insurance policies, coordination of benefits is necessary to ensure that the client does not receive duplicate payments for the same services.
Denial of Coverage
If a claim for case management services is denied by an insurance company, the client may file an appeal. The appeal process typically involves submitting additional documentation or evidence to support the claim.
Avoiding Common Mistakes in Case Management Reimbursement
1. Not understanding your contract
Make sure you thoroughly review your contract with the insurance company. Understand the terms and conditions of the reimbursement, including the rates, covered services, and billing procedures.
2. Billing for services beyond scope of practice
Only bill for services that fall within your scope of practice. If you provide services that are not covered under the contract, you will not be reimbursed.
3. Lack of documentation
Complete and accurate documentation is vital for case management reimbursement. Ensure that your documentation clearly demonstrates the necessity and effectiveness of the services you provide.
4. Errors in billing codes
Use the correct billing codes to describe the services you provide. Inaccurate or incomplete billing codes may lead to denials.
5. Not providing timely billing
Submit your billing claims within the required timeframe. Late submissions may be denied.
6. Not following up on denied claims
If a claim is denied, review the denial reason and contact the insurance company to determine if an appeal is necessary. Don’t give up on reimbursement if a claim is initially denied.
7. Not advocating for your clients
As an advocate for your clients, you should ensure that they receive the benefits and services they’re entitled to. This includes challenging denied claims and negotiating with insurance companies.
8. Not partnering with other professionals
Collaborate with other healthcare professionals involved in your client’s care. This will help you provide comprehensive care and ensure adequate documentation.
9. Lack of education
Stay up-to-date on changes in insurance policies and regulations. Attend industry conferences and seminars to enhance your knowledge.
10. Not staying organized
Maintain a well-organized system for tracking your billing and documentation. This will help you avoid errors and streamline the reimbursement process.
11. Not understanding insurance policies
Familiarize yourself with the different types of insurance policies and how they impact case management reimbursement. This will help you determine eligibility for services and avoid surprises.
12. Not communicating with clients
Keep your clients informed throughout the reimbursement process. Explain the steps involved and provide updates on the status of their claims.
13. Not keeping up with technology
Utilize technology to streamline the reimbursement process. Use electronic billing systems, medical record software, and other tools to improve efficiency.
14. Not using a billing service
Consider using a professional billing service to handle your billing and collections. This can save you time and hassle.
15. Not staying positive
Reimbursement challenges can be frustrating, but it’s important to stay positive and persistent. Don’t give up on getting your clients the reimbursement they deserve.
16. Not double-checking your work
Before submitting a claim, double-check all the details to ensure accuracy. This will help you avoid costly errors.
17. Not being proactive
Don’t wait until you have a problem to address reimbursement issues. Be proactive by staying up-to-date on policies, advocating for your clients, and building relationships with insurance companies.
18. Not managing your expectations
Understand that reimbursement is not always a straightforward process. Be prepared for some delays and denials, and don’t let them discourage you.
19. Not taking advantage of resources
There are many resources available to help you with case management reimbursement. Consult with your colleagues, professional organizations, and online forums.
20. Not delegating tasks
If you are overwhelmed with billing and reimbursement tasks, don’t hesitate to delegate them to your staff or a billing service. This will free up your time to focus on client care.
21. Not being patient
Reimbursement can take time. Don’t expect to get paid immediately after submitting a claim. Follow up regularly and be patient throughout the process.
22. Tips for Success
| Tip | Description |
|---|---|
|
Document thoroughly. |
Keep detailed records of all services provided, including the date, time, duration, location, and interventions used. |
|
Use correct billing codes. |
Refer to the appropriate coding manual (e.g., CPT, HCPCS) to ensure accuracy. |
|
Submit claims promptly. |
File your claims within the specified timeframes to avoid delays or denials. |
|
Follow up regularly. |
Contact the insurance company periodically to check the status of your claims. |
|
Appeal denied claims. |
If a claim is denied, review the reason and file an appeal if appropriate. |
|
Stay up-to-date. |
Attend industry events and read publications to stay informed about changes in reimbursement policies. |
Case Management Reimbursement in the Age of Value-Based Care
Insurance Coverage
Case management services are typically covered by private health insurance, Medicare, and Medicaid. Each payer has its own set of rules and regulations regarding reimbursement, so it is important to verify coverage before providing services.
Private health plans typically require a prior authorization before approving reimbursement for case management services. The plan will need to review the patient’s medical records to determine the need for services and the level of care required.
Medicare covers case management services for beneficiaries who meet certain criteria, such as having a chronic condition or a disability. Services must be medically necessary and provided by a qualified case manager.
Medicaid covers case management services for beneficiaries who are low-income and meet certain eligibility requirements. Services must be provided by a qualified case manager and must be part of a comprehensive care plan.
Reimbursement Rates
Reimbursement rates for case management services vary depending on the payer and the level of care provided. Private health plans typically have the highest reimbursement rates, followed by Medicare and Medicaid.
The level of care provided also affects reimbursement rates. Case management services that require a higher level of training and expertise, such as those provided by a registered nurse or social worker, are typically reimbursed at a higher rate than services provided by a non-clinician.
Billing Procedures
Case managers typically bill for their services on an hourly basis. The hourly rate is set by the payer and may vary depending on the level of care provided.
Case managers must submit a bill to the payer after each service is provided. The bill should include the date of service, the type of service provided, the duration of the service, and the fee charged.
The payer will review the bill and issue a payment to the case manager. The payment may be reduced if the payer determines that the service was not medically necessary or was not provided in accordance with the payer’s rules and regulations.
24. Case Management Reimbursement in a Value-Based Care Environment
In a value-based care environment, reimbursement for case management services is linked to the quality of care provided. Case managers are rewarded for achieving positive outcomes for their patients, such as improved health outcomes, reduced hospitalizations, and lower costs.
To succeed in a value-based care environment, case managers must focus on providing high-quality care that meets the needs of their patients. They must also be able to track and measure the outcomes of their services to demonstrate their value to payers.
The following are some tips for case managers who want to succeed in a value-based care environment:
- Develop a strong understanding of the value-based care model and how it works.
- Identify the quality measures that are important to payers and focus on achieving those measures.
- Track and measure the outcomes of your services to demonstrate your value to payers.
- Collaborate with other providers to provide comprehensive care to your patients.
- Stay up-to-date on the latest research and best practices in case management.
By following these tips, case managers can position themselves to succeed in a value-based care environment and ensure that they are reimbursed fairly for the valuable services they provide.
| Payer | Reimbursement Rates |
|---|---|
| Private health plans | Highest reimbursement rates |
| Medicare | Moderate reimbursement rates |
| Medicaid | Lowest reimbursement rates |
The Future of Case Management Reimbursement
The future of case management reimbursement is uncertain. However, there are a number of trends that are likely to shape the way that case managers are reimbursed in the future.
1. Value-Based Payment Models
Value-based payment models (VBPMs) are reimbursement models that reward providers for the quality of care they provide, rather than the number of services they deliver. VBPMs are becoming increasingly common in healthcare, and they are likely to have a significant impact on the way that case managers are reimbursed.
2. Bundled Payments
Bundled payments are a type of VBPM in which providers are paid a single, fixed amount for all of the services that are provided to a patient during a specific episode of care. Bundled payments are becoming increasingly common in Medicare, and they are likely to be adopted by other payers in the future.
3. Pay-for-Performance
Pay-for-performance (P4P) programs are programs that reward providers for meeting specific quality metrics. P4P programs are becoming increasingly common in healthcare, and they are likely to have a significant impact on the way that case managers are reimbursed.
4. Telehealth
Telehealth is the delivery of healthcare services through telecommunications technology. Telehealth is becoming increasingly common, and it is likely to have a significant impact on the way that case managers are reimbursed. For example, case managers may be able to provide services to patients remotely, which could reduce the cost of care.
5. Big Data
Big data is the collection and analysis of large amounts of data. Big data is becoming increasingly common in healthcare, and it is likely to have a significant impact on the way that case managers are reimbursed. For example, big data can be used to identify patients who are at risk for certain health conditions, which could allow case managers to intervene early and prevent these conditions from developing.
| Payer | Reimbursement Rates | Coverage Criteria |
|---|---|---|
| Medicare | $X per hour | Must be a Medicare-certified case manager |
| Medicaid | $Y per hour | Must be a Medicaid-certified case manager |
| Private Insurance | Varies by insurer | Varies by insurer |
6. Artificial Intelligence
Artificial intelligence (AI) is the use of computers to simulate human intelligence. AI is becoming increasingly common in healthcare, and it is likely to have a significant impact on the way that case managers are reimbursed. For example, AI can be used to automate certain tasks, such as scheduling appointments and tracking patient data, which could free up case managers to spend more time on direct patient care.
7. Patient Engagement
Patient engagement is the involvement of patients in their own healthcare. Patient engagement is becoming increasingly common, and it is likely to have a significant impact on the way that case managers are reimbursed. For example, patient engagement can lead to better health outcomes, which could reduce the cost of care.
8. Interdisciplinary Collaboration
Interdisciplinary collaboration is the collaboration of different healthcare providers to provide care to patients. Interdisciplinary collaboration is becoming increasingly common, and it is likely to have a significant impact on the way that case managers are reimbursed. For example, interdisciplinary collaboration can lead to better health outcomes, which could reduce the cost of care.
9. Policy Changes
Policy changes are changes to the laws and regulations that govern healthcare. Policy changes can have a significant impact on the way that case managers are reimbursed. For example, policy changes could be made to increase the reimbursement rates for case managers or to expand the scope of practice for case managers.
10. Economic Factors
Economic factors, such as the overall economy and the cost of healthcare, can have a significant impact on the way that case managers are reimbursed. For example, if the economy is in a recession, payers may be less likely to increase reimbursement rates for case managers.
Case Manager Reimbursement and Insurance Information
Case managers play a vital role in coordinating and managing care for individuals with chronic or complex medical conditions. They work with patients, families, and healthcare providers to ensure that patients receive the necessary medical, social, and support services. Case managers are typically reimbursed for their services through insurance or government programs.
The amount of reimbursement that a case manager receives depends on a number of factors, including the type of insurance plan, the severity of the patient’s condition, and the geographic location. In general, case managers are reimbursed on an hourly basis, with rates ranging from $50 to $150 per hour. Some insurance plans also offer case management services as part of a bundled payment, which means that the case manager is paid a flat fee for all of the services provided to the patient over a period of time.
To be eligible for reimbursement from insurance, case managers must typically be licensed or certified in their field. They must also have a valid tax identification number and be enrolled as a provider with the insurance company. Case managers should submit claims for reimbursement in a timely manner, and they should include all of the necessary documentation to support their claims.