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Private payers: 'They're trying to push out the little guys' |
By Liz Beaulieu Editor - 10.23.2009
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YARMOUTH, Maine –It turns out HME providers in Florida aren’t alone.
Numerous HME providers in the state reported in July that Blue Cross Blue Shield (BCBS) had sent them letters notifying them that their services would no longer be needed starting Nov. 1, 2009. The reason: The insurer, the state’s largest, used a closed bid process to whittle down its network of providers to 12 for the whole state.
But providers in other states are having problems with private payers, too. Provider Doug Crana says he was approached recently by another provider about sharing a private-pay contract that reimbursed 30% below Medicare’s fee schedule.
“We just shook our heads,” said Crana, president of Consolidated Medical in Newburgh, N.Y. “There would have been volume involved, but there was no way we could do it. It would have been an injustice to the industry. When you accept a contract like that, it doesn’t last. Or there’s a domino effect, with other payers following suit.”
Crana says he’s also heard BCBS is trying to shrink its provider network in New York.
“I have a colleague in Long Island who had a contract with one of the Blues,” he said. “He got a letter that said, ‘If you want to stay in the network, you have to accept this lower reimbursement.’ They’re trying to push out the little guys. Maybe a Lincare can accept those kinds of rates.”
Things are no better in Minnesota. For some private payers, provider Alicia Trubenbach has seen a 12% cut across-the-board and a steeper cut, up to 30% to 40%, for higher-end electronics for wheelchairs.
“The payers that used to be the ones that we breathed a sigh of relief about have turned into our nemeses,” said Trubenbach, a sales manager for Reliable Medical Supply in Minneapolis.
Back in Florida, provider Carl Wallman’s trying to figure out what to do, now that he’s out a BCBS contract. He’s also out a Medicaid contract, after several of the HMOs charged with administering the program in the state were sold to Molena Healthcare.
“For us, it’s not necessarily what we’re getting paid, but not having access to patients,” said Wallman, president of Galaxy Medical in Fort Lauderdale. “All of these doors are closing.”
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HME News Info Center |
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| 8-8 They’re Auditing Me! What Do I Do Now? | Attendance is $99
During this event, Andrea Stark will walk you through the entire audit process step-by-step, from the moment you receive a request for additional documentation, through the time you submit your initial response and (if necessary) your appeal. Most importantly, Andrea will ensure you gain a clear understanding of your full rights while undergoing an audit.
For more information or to register, visit: http://www.miravistallc.com/recent_services.php.
| | 13-13 “Contracting Time is Here: Do You Know Your Game Plan?” | In Cincinnati on July 13.
While the DME provider community continues to work strenuously to repeal the competitive bidding program, the VGM National Competitive Bidding Services team is hitting the road again. Throughout July and August, the group will be co-hosting, along with respective state associations, full-day seminars, “Contracting Time is Here: Do You Know Your Game Plan?” The series will be presented by Mark Higley, vice president-development; John Gallagher, vice president-government relations; Alan Morris, regulatory analyst, all from VGM; and attorney Neil Caesar, president, Health Law Center. The series, designed for all providers affected by the bidding program, will focus on:
· Detailed overview of the contractual obligations for bid winners.
· Discussion about financially evaluating a bidding contract, including a take-home comprehensive Contract Evaluation Toolkit.
· Legal advice and legal document templates for subcontracting and change of ownership.
· Dos, don’ts, and tips on marketing your competitive bidding contract or subcontracting agreement.
· In-depth legislative update on activity on Capitol Hill related to the effort to repeal competitive bidding, as well as other DME industry issues.
| | 13-13 Pre-Payment Reviews and RAC Audits | “Pre-Payment Reviews and RAC Audits: Steps to Prepare for and Survive These Life-Altering Events," presented by Jeffrey Baird, Esq., Brown & Fortunato, P.C. Call AAHomecare for details: 703.836.6263.
| | 14-14 “Contracting Time is Here: Do You Know Your Game Plan?” | In Pittsburgh on July 14.
While the DME provider community continues to work strenuously to repeal the competitive bidding program, the VGM National Competitive Bidding Services team is hitting the road again. Throughout July and August, the group will be co-hosting, along with respective state associations, full-day seminars, “Contracting Time is Here: Do You Know Your Game Plan?” The series will be presented by Mark Higley, vice president-development; John Gallagher, vice president-government relations; Alan Morris, regulatory analyst, all from VGM; and attorney Neil Caesar, president, Health Law Center. The series, designed for all providers affected by the bidding program, will focus on:
· Detailed overview of the contractual obligations for bid winners.
· Discussion about financially evaluating a bidding contract, including a take-home comprehensive Contract Evaluation Toolkit.
· Legal advice and legal document templates for subcontracting and change of ownership.
· Dos, don’ts, and tips on marketing your competitive bidding contract or subcontracting agreement.
· In-depth legislative update on activity on Capitol Hill related to the effort to repeal competitive bidding, as well as other DME industry issues.
| | 15-15 “Contracting Time is Here: Do You Know Your Game Plan?” | In Orlando July 15.
While the DME provider community continues to work strenuously to repeal the competitive bidding program, the VGM National Competitive Bidding Services team is hitting the road again. Throughout July and August, the group will be co-hosting, along with respective state associations, full-day seminars, “Contracting Time is Here: Do You Know Your Game Plan?” The series will be presented by Mark Higley, vice president-development; John Gallagher, vice president-government relations; Alan Morris, regulatory analyst, all from VGM; and attorney Neil Caesar, president, Health Law Center. The series, designed for all providers affected by the bidding program, will focus on:
· Detailed overview of the contractual obligations for bid winners.
· Discussion about financially evaluating a bidding contract, including a take-home comprehensive Contract Evaluation Toolkit.
· Legal advice and legal document templates for subcontracting and change of ownership.
· Dos, don’ts, and tips on marketing your competitive bidding contract or subcontracting agreement.
· In-depth legislative update on activity on Capitol Hill related to the effort to repeal competitive bidding, as well as other DME industry issues.
| | 20-20 "Contracting Time is Here: Do You Know Your Game Plan?" | In Dallas on July 20.
While the DME provider community continues to work strenuously to repeal the competitive bidding program, the VGM National Competitive Bidding Services team is hitting the road again. Throughout July and August, the group will be co-hosting, along with respective state associations, full-day seminars, “Contracting Time is Here: Do You Know Your Game Plan?” The series will be presented by Mark Higley, vice president-development; John Gallagher, vice president-government relations; Alan Morris, regulatory analyst, all from VGM; and attorney Neil Caesar, president, Health Law Center. The series, designed for all providers affected by the bidding program, will focus on:
· Detailed overview of the contractual obligations for bid winners.
· Discussion about financially evaluating a bidding contract, including a take-home comprehensive Contract Evaluation Toolkit.
· Legal advice and legal document templates for subcontracting and change of ownership.
· Dos, don’ts, and tips on marketing your competitive bidding contract or subcontracting agreement.
· In-depth legislative update on activity on Capitol Hill related to the effort to repeal competitive bidding, as well as other DME industry issues.
| | 20-20 Audits…a Four Letter Word | “Audits…a Four Letter Word: How to Prepare for and Respond to DME MAC and ZPIC Audits,” presented by Jeffrey Baird, Esq., Brown & Fortunato, P.C. Call AAHomecare for more details: 703.836.6263.
| | 21-21 "Contracting Time is Here: Do You Know Your Game Plan?" | In Kansas City July 21.
While the DME provider community continues to work strenuously to repeal the competitive bidding program, the VGM National Competitive Bidding Services team is hitting the road again. Throughout July and August, the group will be co-hosting, along with respective state associations, full-day seminars, “Contracting Time is Here: Do You Know Your Game Plan?” The series will be presented by Mark Higley, vice president-development; John Gallagher, vice president-government relations; Alan Morris, regulatory analyst, all from VGM; and attorney Neil Caesar, president, Health Law Center. The series, designed for all providers affected by the bidding program, will focus on:
· Detailed overview of the contractual obligations for bid winners.
· Discussion about financially evaluating a bidding contract, including a take-home comprehensive Contract Evaluation Toolkit.
· Legal advice and legal document templates for subcontracting and change of ownership.
· Dos, don’ts, and tips on marketing your competitive bidding contract or subcontracting agreement.
· In-depth legislative update on activity on Capitol Hill related to the effort to repeal competitive bidding, as well as other DME industry issues.
| | 22-22 "Contracting Time is Here: Do You Know Your Game Plan?" | In Charlotte, N.C., July 22
While the DME provider community continues to work strenuously to repeal the competitive bidding program, the VGM National Competitive Bidding Services team is hitting the road again. Throughout July and August, the group will be co-hosting, along with respective state associations, full-day seminars, “Contracting Time is Here: Do You Know Your Game Plan?” The series will be presented by Mark Higley, vice president-development; John Gallagher, vice president-government relations; Alan Morris, regulatory analyst, all from VGM; and attorney Neil Caesar, president, Health Law Center. The series, designed for all providers affected by the bidding program, will focus on:
· Detailed overview of the contractual obligations for bid winners.
· Discussion about financially evaluating a bidding contract, including a take-home comprehensive Contract Evaluation Toolkit.
· Legal advice and legal document templates for subcontracting and change of ownership.
· Dos, don’ts, and tips on marketing your competitive bidding contract or subcontracting agreement.
· In-depth legislative update on activity on Capitol Hill related to the effort to repeal competitive bidding, as well as other DME industry issues.
| | 29-29 "Contracting Time is Here: Do You Know Your Game Plan?" | In Miami on July 29.
While the DME provider community continues to work strenuously to repeal the competitive bidding program, the VGM National Competitive Bidding Services team is hitting the road again. Throughout July and August, the group will be co-hosting, along with respective state associations, full-day seminars, “Contracting Time is Here: Do You Know Your Game Plan?” The series will be presented by Mark Higley, vice president-development; John Gallagher, vice president-government relations; Alan Morris, regulatory analyst, all from VGM; and attorney Neil Caesar, president, Health Law Center. The series, designed for all providers affected by the bidding program, will focus on:
· Detailed overview of the contractual obligations for bid winners.
· Discussion about financially evaluating a bidding contract, including a take-home comprehensive Contract Evaluation Toolkit.
· Legal advice and legal document templates for subcontracting and change of ownership.
· Dos, don’ts, and tips on marketing your competitive bidding contract or subcontracting agreement.
· In-depth legislative update on activity on Capitol Hill related to the effort to repeal competitive bidding, as well as other DME industry issues.
| | 29-29 Have PECOS Questions? Get Straight Answers, Live! | July 29, 2010 @ 2:00pm EST
Due to the increasing number of inquiries MiraVista is receiving regarding the July 6 PECOS physician enrollment deadline and January 3, 2011 rejection implementation date, we have decided to hold this timely PECOS webinar. The majority of the webinar will be held as an open forum for suppliers to ask and receive answers to their PECOS questions directly from DME consultant Andrea Stark.
Cost is $99. Register at: http://www.miravistallc.com/recent_services.php.
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| 9-9 DMEPOS Billing Workshop: Maintaining Compliance with the Medicare Program | August 9, 2010 – Columbia, SC – 9am-5pm EST
Whether you’re looking to reduce the number of audits you are receiving or need to stay up to date on current documentation requirements for various DME, this DMEPOS billing workshop is for you! Both seasoned billers and new trainees will benefit from this course, as Andrea Stark lays the foundation for continued compliance with the Medicare program, and provides updates on recent policy changes and claims edits.
Cost is $295 for the first attendee, $225 each additional. Register at: http://www.miravistallc.com/recent_services.php.
| | 10-10 "Contracting Time is Here: Do You Know Your Game Plan?" | In Cleveland on Aug. 10.
While the DME provider community continues to work strenuously to repeal the competitive bidding program, the VGM National Competitive Bidding Services team is hitting the road again. Throughout July and August, the group will be co-hosting, along with respective state associations, full-day seminars, “Contracting Time is Here: Do You Know Your Game Plan?” The series will be presented by Mark Higley, vice president-development; John Gallagher, vice president-government relations; Alan Morris, regulatory analyst, all from VGM; and attorney Neil Caesar, president, Health Law Center. The series, designed for all providers affected by the bidding program, will focus on:
· Detailed overview of the contractual obligations for bid winners.
· Discussion about financially evaluating a bidding contract, including a take-home comprehensive Contract Evaluation Toolkit.
· Legal advice and legal document templates for subcontracting and change of ownership.
· Dos, don’ts, and tips on marketing your competitive bidding contract or subcontracting agreement.
· In-depth legislative update on activity on Capitol Hill related to the effort to repeal competitive bidding, as well as other DME industry issues.
| | 17-17 "Contracting Time is Here: Do You Know Your Game Plan?" | In Riverside, Calif., on Aug. 17.
While the DME provider community continues to work strenuously to repeal the competitive bidding program, the VGM National Competitive Bidding Services team is hitting the road again. Throughout July and August, the group will be co-hosting, along with respective state associations, full-day seminars, “Contracting Time is Here: Do You Know Your Game Plan?” The series will be presented by Mark Higley, vice president-development; John Gallagher, vice president-government relations; Alan Morris, regulatory analyst, all from VGM; and attorney Neil Caesar, president, Health Law Center. The series, designed for all providers affected by the bidding program, will focus on:
· Detailed overview of the contractual obligations for bid winners.
· Discussion about financially evaluating a bidding contract, including a take-home comprehensive Contract Evaluation Toolkit.
· Legal advice and legal document templates for subcontracting and change of ownership.
· Dos, don’ts, and tips on marketing your competitive bidding contract or subcontracting agreement.
· In-depth legislative update on activity on Capitol Hill related to the effort to repeal competitive bidding, as well as other DME industry issues.
| | 19-19 Revisiting Patient Pay: Are you leaving $ on the table? | August 19, 2020 @ 2:00pm EST
Your front-end could be the reason patient AR is ballooning. Join Andrea Stark for this informative webinar and ensure you’re taking advantage of every opportunity to proactively secure payments and reduce future collection efforts.
Cost is $49. Register at: http://www.miravistallc.com/recent_services.php
| | 31-31 MESA Fall Conference 2010 | Aug. 31-Sept. 3 in Dallas. Wondering what the future holds for DME? For your company? Obviously, no one knows ... but we all hope for the best ... and the best idea is to be prepared. MESA's Fall Conference 2010, is sure to be a comprehensive, education- and information-packed event for the HME/DME provider and staff ... and an excellent way to get prepared for your company's future in the HME industry! FMI: http://www.mesanet.org/index.php?cid=5282&src=gendocs&ref=Fall_Conference_2010_Index&category=Conferences&curlid=495
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| 2-2 Can You Really Do That? Debunking Medicare Myths | September 2, 2010 @ 2:00pm EST
This webinar will set out to distinguish the difference between Medicare myths and reality. Participants will learn what is really acceptable under Medicare guidelines and will have the opportunity to get their own Medicare myths debunked.
Cost is $99. Register at: http://www.miravistallc.com/recent_services.php
| | 12-14 2010 HME News Business Summit | Data and Market Intelligence You Can’t Get Anywhere Else!
The tools and strategies you need to drive revenue and cut costs are at the 2010 HME News Business Summit. We deliver real-life case studies, original research and industry benchmarks. Join your peers for two days of top-notch education and networking.
Nashville Hilton Downtown
Nashville, Tenn.
To review the educational program: http://www.hmesummit.com/speakers.html
To register: https://www.b2bmediaportal.com/hmesummit/hmesummit.aspx
| | 13-17 Blue Ridge Symposium | Four conferences in one week. Choose your specialty or area of interest: Sleep Conference; Asthma Education;Home Care Conference; Respiratory Care Conference
Earn at least six CRCE/CEUs everyday
Location: Blue Ridge Shadows, Front Royal, Va.
Visit us on the Web at: www.valleyhealthlink.com/brs
Contact us at: brs@valleyhealthlink.com
or Call (540) 536-8941
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| 6-7 JAMES 2010 Annual Conference | This year's theme: "Barriers to Boomers - How to Overcome and Prosper." The conference will be held at the Ocean Place Resort & Spa in Long Branch, N.J. FMI: www.jamesofnj.org.
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| 16-18 Medtrade | Georgia World Congress Center in Atlanta.
Medtrade connects the HME industry. Stay ahead of HME industry changes and find the latest tools to help your clients. Join us at the largest home medical equipment even in the western US as we bring more exhibitors, more ideas, and more products than ever before.
Visit www.medtrade.com for more information and to register.
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