Ask an Expert

Partnering with health care is uncharted territory for many aging and disability community-based organizations—and we realize you may need a little help along the way. The Aging and Disability Business Institute has assembled a roster of experts to answer any question aging and disability community-based organizations might have. Check out the FAQs below to see if we’ve covered what you’re looking for.

Search Ask An Expert

Search the Ask an Expert archive to find out whether we’ve already answered your question.

Don’t see what you’re looking for?

I’ve heard a lot about how CBOs might be able to tap into Medicare reimbursement for certain services. What is the latest on that opportunity?

You’ve heard correctly! While Medicare billing has not traditionally accounted for a large portion of CBO revenue, and few CBOs have had mechanisms in place to tap into this payment stream, that is changing rapidly as new Medicare codes and a proliferation of value-based payment reforms are incentivizing the kinds of preventative and community-support services CBOs provide. These new policy developments have opened up opportunities for CBOs to more fully integrate with the health care sector—and get paid in the process. Please see below for a high-level overview of issues related to CBOs and Medicare.

  •  Most of the current CBO Medicare reimbursement opportunities are available under Medicare Part B, which covers physician services, office visits, screenings, therapies, preventative care, and other outpatient services. Learn more about Medicare Part B on
  •  A Medicare Provider number is the key to being able to bill for services. A CBO can either go through the process to obtain its own Medicare Provider number to bill directly for some services or partner with an existing provider that has its own Medicare number to receive reimbursement. Different benefits have different rules for who exactly can bill Medicare directly. Learn more about whether becoming a Medicare provider is right for your CBO  in the Business Institute’s Becoming a Medicare Fee-For-Service Provider: What CBOs Need to Know
  •  Currently, most of the Medicare billing for CBOs is centered around self-management, health and wellness promotion programs, care transitions, and well as care management services. There are a number of Medicare Part B benefits that can be offered to obtain reimbursement for Chronic Disease Self-Management Education (CDSME) programs by billing Medicare directly. However, it is important to note that for the Chronic Care Management (CCM) and Complex Chronic Care Management (Complex CCM) services described below, a CBO cannot bill Medicare directly. They must partner with a physician or an eligible non-physician practitionerwho can submit bills to Medicare for reimbursement.

Below are the benefits most commonly furnished by CBOs, along with their corresponding billing codes. (Note: CPT codes stand for Current Procedural Terminology codes. CPT codes are a set of medical billing codes that are developed and owned by the American Medical Association.) 

Diabetes Self-Management Training (DSMT)

Medical Nutrition Therapy (MNT)

Health Behavior and Assessment Intervention (HBAI)

Chronic Care Management (CCM)

Complex Chronic Care Management (Complex CCM)

How do I contact the Managed Care Organizations (MCOs) and what do I say?

The answer to this questions depends somewhat on the environment in your community and state. For example, if your state is considering a move to managed long term services and supports (MLTSS), you will want to talk with the state agency responsible for the bid process. You will be interested in learning which MCOs are considering making a bid in your state or geographic region. In many instances, the MCOs will actual contact you, so be prepared for that call! For more information and tools on talking with MCOs and other payers, visit our Resource Library under the Define Your Value category.

How might a new Administration impact CBO-health care integration work?

Recognition of the value patients receive through integrated care continues to grow and part of that recognition is an understanding of the impact social determinants have on an individual’s overall health and well-being. The purpose of the Business Institute is to help CBOs develop their business acumen skills to partner with health and managed care organizations. By doing so, CBOs bring value to their communities, value to their partner organizations and other funders, and value to the individuals and caregivers we all serve. Change is inevitable with any new Administration and, regardless of any changes that may be proposed, where CBOs demonstrate their value, this work will continue and will be an essential part of future integrated care models, to the well-being of older adults and persons with disabilities across the nation.

What is a Medicare Provider Number, do I need one, and how I can I apply for one?

A Medicare Provider Number, officially a National Provider Identifier (NPI), is provided by the Centers for Medicare and Medicaid Services (CMS) to registered providers that allows that individual or, in some cases an organization, to bill Medicare or your state Medicaid program for covered services. First, your CBO will want to determine if it offers services that traditional Medicare or your state's Medicaid program may pay for. If so, your CBO may wish to secure (directly or through an affiliate organization) a NPI. To learn more about potential CBO-Medicare billable services, click here. For instructions on how to obtain a Medicare Provider Number, click here.

What is driving the push toward integrated care, and why do I need to know about it?

Health care systems and their payers are rapidly moving away from pay-for-service and toward pay-for-value. As part of this evolution, there is an increasing level of recognition that addressing social determinants of health (e.g., physical environments, social support networks, etc.) should be an integral part of a patient’s health care. As health plans and systems look for ways to reduce costs and improve quality, CBOs must partner with them to expand access to evidence-based health promotion programs, nutritious food, transportation and other services for older adults and people with disabilities. These powerful motivators are driving change throughout the health care system and CBOs need to understand and embrace a new, integrated role as part of the public-private shift towards measuring and rewarding value.

Is my organization allowed to charge for services?

The short answer is, maybe. If your state has adopted or will soon adopt managed long term services and supports (MLTSS), reach out to the managed care organizations (MCOs) bidding on or contracting with the state to manage its MLTSS program and discuss opportunities to work together. Do your homework and to be certain you understand what LTSS the state is including and, if available, what the state's rate is for that service(s).

Be prepared to discuss your CBO's value proposition and why the MCO should contract with you to provide the covered service(s) to its members. Be creative! States typically apply performance and patient outcome measures that focus on achieving better care, better health and lower costs. Be certain you understand these incentives and how your CBO's proposed services can help that MCO improve their clients' health, increase satisfaction, and lower health care costs.

What health care partnership opportunities are available for CBOs? And what progress have CBOs made in contracting with health care entities?

CBOs are involved in a variety of health care initiatives across the nation, including Accountable Care Organizations (ACOs)Managed Long-Term Services and Supports (MLTSS), Medicare Advantage,  Veterans Affairs-Home and Community Based Services (VA-HCBS), private pay, Patient Centered Medical Homes (PCMH), Program for All-Inclusive Care for the Elderly (PACE) and more.

Over the past several years, the Business Institute has observed a clear trend in CBO-health care contracting: more health care providers and payers are turning to CBOs to help them address the unmet social needs of older adults and people with disabilities in the community. Data from the Business Institute’s recurring Request for Information (RFI) survey shows that an increasing percentage of responding CBOs are engaging in contractual arrangements with health care organizations. Learn about these trends and more from our latest RFI in this webinar: Contracting Between Community-Based Organizations and Health Care: New Insights from the 2020 RFI.

How do I know if my organization is ready to undertake health care partnerships?

One of the best ways to learn whether your CBO is ready for health care contracting is to conduct a thorough and objective examination of your CBO’s existing service offerings, internal capacity, structure, financing and general business acumen. The Business Institute hosts a suite of assessment tools where you can find tools that will help your CBO evaluate external factors, opportunities, network readiness and more. The Business Institute’s Readiness Assessment is designed to help CBOs determine their readiness across several capacities and skills organizations should develop to prepare for successful cross-sector partnerships. Consultants from our Consulting Program are also available to help you assess the organization’s readiness (a fee-based program).

How can I convince a health care entity to pay for my organization’s services?

Your CBO’s value proposition is your strongest tool when trying to convince a health care entity to pay for your CBO’s services. Determine what your potential health care partner needs and identify the service offerings your CBO can provide to address those needs. Remember that this is essentially marketing, and you are now entering a competitive space. Packaging, pricing and people are three critical ingredients to your CBO’s value proposition. Focus on these to ensure that you are offering and effectively communicating a serious value proposition that addresses a key need for your potential partner. The Business Institute’s How to Guide and Worksheet: Developing Your Value Proposition for Medicare Advantage Plans can help guide your organization through the process of developing a compelling value proposition when seeking to contract with Medicare Advantage plans.

I’m interested in pursuing health care partnerships. How can I get more help with this process?

You’ve come to the right place! The Business Institute is the premier source for guidance and assistance as your CBO navigates the changing landscape of integrated care. If you have specific questions, submit them using our Ask an Expert form. If you need additional assistance, submit a more detailed, targeted request on our Technical Assistance Request form. You can also use the Consultant Request form to let us know about your needs and we’ll connect you to an experienced consultant.

How do I price my services?

The best place to start is with an assessment of your current cost structure for the service(s) under your existing program(s). A partial list of additional considerations may include liability insurance, performance standards (response times, etc.), metrics (percent reduction in readmit rates), the impact of variability in volume and scale, payment incentives (or penalties), and any additional provision that you may consider in your contract negotiations with the MCO that may shift non-fixed costs to your agency (capitated rates, etc.). For more information on pricing, take a look at the Business Institute’s Pricing CBO Services in a New Health Care Environment and browse our pricing-specific resources, visit our Resource Library's Manage Finances category.