Providers struggle with TPAs

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Friday, November 15, 2019

YARMOUTH, Maine – The resurgence of third-party administrators for HME is bad news for the industry, according to the large majority of respondents to a recent HME Newspoll.

TPAs are unnecessary middlemen between insurers and providers, further complicating an already complex system, respondents say.

“We don’t need another level of bureaucracy that has to be paid by somebody, typically the provider in the long run,” wrote one respondent.

Eighty-six percent of respondents report currently having TPAs in their states, a development they say they’re very concerned about.

At the top of their concerns: TPAs typically pay less—and they take their time doing it, according to 66% of respondents.

“Supplier reimbursement is decreased substantially,” wrote one respondent. “The TPA implements additional administrative burdens. The TPA collects above and beyond what the supplier is paid directly from the patient. The only party benefiting from the third-party arrangement is the TPA.”

Other top concerns, according to respondents: closed networks (12%), and reduced services and access issues (14%).

“My biggest concern about this payment model has always been that the TPA would hold back equipment from patients that they really need, just to increase their own profitability,” wrote Josh Turner, a billing manager in Decatur, Ala. “Traditional payers have done the same thing at times, but it seems TPAs will have even greater influence. It takes control away from the patient and provider.”

Respondents are also concerned about what can be blurred lines between some TPAs and certain providers in their networks. At least one TPA is owned by a larger provider, raising concerns about self-referrals, one respondent noted.

“Self-referrals will happen,” wrote the respondent. “This is not right, or good for patients.”