Get 'rock solid' with Medicare Advantage

'I’m not convinced retail is the best idea'
Friday, April 5, 2013

YOUNGSTOWN, Ohio – A self-proclaimed “lifer” in the HME industry has started a company to steer providers away from Medicare fee-for-service. And no, it has nothing to do with retail.

Tom Ivany launched Benefits365 to help providers crack the Medicare Advantage market.

“There’s a lot of talk about the retail model, but I’m still not convinced that it’s the best idea,” said Ivany, who also owns Youngstown, Ohio-based On-Demand Respiratory. “That’s why we started this company. Medicare Advantage is a way for providers to continue servicing their patients.”

When providers partner with Benefits365, they receive educational pieces on Medicare Advantage that they then provide to beneficiaries. One way to do that is through monthly statements. The idea: A beneficiary calls Benefits365 to switch from Medicare to Medicare Advantage, and both the beneficiary and the provider benefit from working with the latter vs. the former.

The biggest benefits of working with Medicare Advantage are fewer audits, no deductibles and reimbursement that hasn’t been cut nearly in half by competitive bidding, says Tyler Poole.

“If we’re talking about $200 in reimbursement, you’re talking $100 under Round 2 of competitive bidding,” said Poole, vice president of operations. “The Medicare Advantage plans are coming in at anywhere from $120 to $170.”

To keep the arrangement above board, Benefits365 doesn’t charge providers or beneficiaries for its services; it collects money from the Medicare Advantage plans. Benefits365 has contracts with, among others, United Healthcare, Anthem Blue Cross and Humana, and expects to add more.

“In 2013, more than 200 Medicare Advantage plans were added nationwide,” Poole said.

While Medicare Advantage hasn’t been immune from cuts—there were small reductions included in the healthcare law—it’s nothing compared to Medicare, Ivany says.

“We’re very nervous about what’s coming with competitive bidding,” said Ivany, who won’t be pursuing Medicare Advantage business at his HME company to avoid conflict of interest. “That’s why I feel confident that we have something rock solid with Benefits365. It’s something that will truly help the industry.”