Tag: Payer Relations

PHOENIX – When an HME provider approaches a managed care organization for the first time, 98% of the time they’re going to hear no, says Julie Rhodovi, senior vice president, payor and regulatory relations, RestorixHealth and AMT. Here’s what Rhodovi, who will be hosting a session at Medtrade West on managed care, has to say about winning insurers over and why it’s worth it.   HME News: What do providers need to keep in mind when it comes to managed care?  Julie...

ARLINGTON, Va. - AAHomecare seeks an experienced professional for its payer relations team. The new manager of payer relations will work closely with Laura Williard, vice president of payer relations, and David Chandler, senior director of payer relations, to support development of ongoing industry strategy regarding payer and state relations involving commercial managed care, Medicaid managed care organizations, Medicare Advantage and state Medicaid programs. This position will help to support all...

ATLANTA - The best way for HME providers to turn payers into allies is by focusing on the patient, says Kris Srinivasan, director of payer relations at McKesson. Here’s what Srinivasan, who hosted a session on improving payer relations at Medtrade East, has to say about achieving optimal care at reasonable costs. HME News: What’s a major do/don’t when talking to payers? Kris Srinivasan: A major don’t is starting the conversation with how much you pay for a medical supply...

WASHINGTON – The payer relations team at AAHomecare is working with state and regional associations to pick off attempts by managed care organizations and other insurers to decrease reimbursement for HME.  Stakeholders have a number of bills working their way through state legislatures to protect reimbursement for DME at 100% of the state Medicaid fee schedules. One of those states: New York, where A.5368 is scheduled to go before the Rules Committee before heading to the floor for...

WASHINGTON – The payer relations team at AAHomecare is working with its association partners to craft a letter asking state governments to include HME in their allocation of millions of dollars in federal funding from the American Rescue Plan Act. President Joe Biden signed the $1.9 trillion act, also known as the COVID-19 Stimulus Package, in March, providing, among other things, $195.3 billion to states and the District of Columbia to help them cover increased expenditures, replenish lost...

WASHINGTON - AAHomecare's payer relations team is involved in ongoing meetings and conversations in 46 states to encourage Medicaid to follow Medicare's lead in covering beneficiaries with acute respiratory conditions, and relaxing documentation, testing and other requirements during the coronavirus pandemic. The association has also developed a draft letter with extensive policy recommendations for state/regional associations to share with Medicaid officials nationwide. “AAHomecare will continue...

Q. What is the role of HME trade associations in payer relations efforts?A. Working with your state/regional association and AAHomecare can help you become more educated and engaged on payer relations issues. These associations represent the collective provider community, and provide input and advocate for HME policy priorities to a wide range of payers. Building relationships with government and commercial payers is a necessary function for associations so that when issues come up and solutions...

Q. What are the pros and cons of solving state Medicaid issues with regulation vs. legislation?A. There are two principal paths to solving state Medicaid issues: either through regulation or legislation. Both are effective ways of resolving issues, but each comes with their own costs and benefits. It is typically a good idea to start with the regulatory approach so that you don't burn any bridges with state regulators and overlook any potential allies. However, I always recommend weighing the pros...

Q. What are some of the most common problems faced when it comes to payer relations?A. Payer relations professionals face a wide range of problems on any given day, but the most common issues can be categorized under three main topics: working with Medicaid managed care organizations (MCOs), identifying who to contact at a payer, and determining the most efficient way to solve a problem with a payer. Knowing how to navigate these problems gives anyone in payer relations an advantage.The first issue...

Q. What is payer relations and why is it so important?A. You may have contemplated this question and wondered why many companies are putting so many resources into this area. Simply put, payer relations (also referred to as payor relations by some) describes operations that work with a range of third-party payers to make sure patients have access to high quality equipment and care.  Payer relations goals can be accomplished in three general ways: by working directly with insurance companies,...