Payers, providers restructure home

Friday, January 31, 2003

ALEXANDRIA, Va. - Payers are beginning to restructure their contracts with providers to comply with new standardized home infusion codes under HIPAA, and it’s sometimes a stressful affair, industry sources say.

Payers have to start using the new codes in eight months, but they’re beginning to phase them in now, so their businesses won’t come to a grinding halt in October, according to Lorrie Kline Kaplan, executive director of the National Home Infusion Association.

“There almost isn’t a payer in the country whose codes are set up exactly like the new ones,” Kaplan said.

Kaplan said restructuring contracts could yield positive or negative results for providers. On one hand, it gives them a chance to renegotiate contracts so they increase their margins. Of course, it could go the other way, too, and that’s the stressful part.

“This is really a call to providers to spell out the services they’re offering,” she said.

Stephen Schmahl, v.p. of contracts and pricing for Denver-based home infusion giant Coram, said the company is 12 months into its efforts to phase in the new codes. He said restructuring contracts can be a lot of work, but in the end, providers and payers will be able to compare rates apples-to-apples.

That’s the exciting part, Kaplan said.

“Ultimately, so many good things are going to come out of this,” she said. “Our lives will be easier, and there’ll be savings that can be used to provide better care. There’s a waste of resources right now.” HME