Medicare Claim Management: Impacts of the Aging Population and Shifting Payor Mixes

Medicare Claim Management: Impacts of the Aging Population and Shifting Payor Mixes

Presented by Christine Fontaine

Wednesday June 18th, 2025
10am PT / 11am MT / 12pm CT / 1pm ET

This program is scheduled for 60 minutes and is valid for 1 CHBME credit.

Member Price: $49.00
Non Member Price: $99.00

Description:
As the Baby Boomer generation continues aging into Medicare, the healthcare industry faces significant challenges due to shifting payer mixes, rising administrative burdens, and evolving patient expectations:

1. Unprecedented demand, with a 28% increase in the percent of population aged 65 and over
2. Shifting reimbursement models, with 64% of Medicare beneficiaries enrolled in Medicare Advantage plans vs traditional Medicare
3. Increasing administrative burden, with 99% of Medicare Advantage enrollees in plans requiring prior auth for some services and a 55.7% increase in care denials from Medicare Advantage plans between 2022-2023
4. Hidden coverage, with up to 40% of presumed self-pay patients having insurance coverage — commercial, governmental, or a combination
5. Patient loyalty, with 82% of patients claiming they will stay with a provider if the experience of doing business is very easy

To address these complexities, this presentation will outline best practices for optimizing Medicare billing and collections end to end.

We’ll start with strategies to ensure clean claims from the start, such as verifying eligibility in real time and proactively identifying potential coverage issues to minimize errors and streamline claim submissions.

Then we’ll review denial prevention strategies with insights on how organizations can leverage automated prior authorization strategies and Medicare-specific claim edits to prevent denials before they occur. However, as we all know, denials are still on the rise, so we will also cover identification and prioritization of denials most likely to be overturned, and tricks for increasing efficiency of the appeal process.

Additionally, we’ll examine ways to enhance the patient financial experience, including offering convenient payment options and flexible payment plans to support cash flow and patient satisfaction. Finally, we’ll highlight the role of data-driven insights in optimizing this entire process from claim submissions, to reducing denials, and improving collections.

By implementing these end-to-end strategies, healthcare organizations can navigate the complexities of the Medicare landscape more effectively, reduce revenue leakage, and improve both operational workflows and overall patient experience.

Webinar Objectives:
Course participants will be able to:

• A plan to automate Medicare claims workflows
• Knowledge of easy ways to achieve Medicare compliance
• And an understanding of tools you can access that will allow for visibility into your Medicare claims that will allow you to mitigate denials and get paid more quickly and in full

Speaker Bio:
Christine Fontaine is currently a Growth Enablement Solution Strategist at Waystar. As part of her role, she assists healthcare providers identify solutions to help optimize their revenue cycle.

Prior to joining Waystar, she was Vice President, Revenue Cycle Solutions with Optum360. In this role, she ensured that RCMS delivers competitive healthcare services to the market while maximizing company resources, and reliably contribute to the business results and strategic plan of the organization. She oversaw the coordination of cross functional teams, and guide the development, launch, delivery, and operation of the RCMS service line.

Christine served as the Director of Revenue Cycle Operations for Shore Health System, a member of the University of Maryland Medical System. In this role, Christine directed the Centralized Scheduling Department, Registration, Switchboard, Chargemaster Oversight, and Patient Financial Services departments at Shore Health System, along with running system initiatives related to the revenue cycle for UMMS.

Christine has been in the healthcare finance field for over 20 years, in both physician and hospital business offices. She has held management positions at Memorial Sloan Kettering, Montefiore Medical Center, Cornerstone Treatment Facilities and Shore Health System/University of Maryland Medical System. Christine is a Certified Healthcare Financial Professional, and is actively involved in AAHAM and HFMA. She served on the HFMA Board of Examiners, National Advisory Council and Revenue Cycle Forum. She has presented at HFMA, AAHAM, Meditech and other conferences on various topics related to revenue cycle operations.