Skip to Content

Tag: managed care

Also Noted

State round up: Florida, Louisiana, Ohio

October 2, 2020HME News Staff

AAHomecare has submitted a letter to Sunshine Health and Wellcare in Florida, expressing its concerns with the consolidation of services under one company and the state's history of failure with such an arrangement. The letter cites inequities in fee schedules; the elimination of patient choice; and the risk of network collapse as primary concerns. AAHomecare has also asked that Centene exclude self-referrals in its request for proposal to the state to cover the management of HME and home health...

aahomecare, HOme medical equipment, managed care, WellCare

Read Full Articlered right arrow icon

Also Noted

NSM now in-network with Prime Health Services

July 28, 2020HME News Staff

NASHVILLE, Tenn. - National Seating & Mobility has been designated as a preferred complex rehab and home accessibility provider for Prime Health Services, a managed care company specializing in preferred provider networks. Prime Health's network provides workers' compensation, and auto and group health solutions for insurance carriers, third-party administrators, self-insureds and government entities. The new relationship authorizes NSM branches nationwide as approved and in-network. “Prime...

managed care, NSM, Prime Health Services

Read Full Articlered right arrow icon


North Carolina rate protects DME

July 7, 2020HME News Staff

RALEIGH, N.C. - North Carolina Gov. Roy Cooper on July 2 signed Bill 808, including a provision creating a rate floor for durable medical equipment.The bill, a year in the making by groups like ACMESA and AAHomecare, prohibits managed care organizations from setting rates below the state's Medicaid fee-for-service rates for DME.“ACMESA's strong relationship with AAHomecare enabled us to learn from the problems experienced in other states as they rolled out their MCO programs,” said Craig...

managed care, medicaid, North Carolina, rate protection

Read Full Articlered right arrow icon


Payers tighten their control

February 14, 2020Theresa Flaherty, Managing Editor

ST. LOUIS - As big payers get ever bigger, HME providers and stakeholders fear the impact these monopolies could have on the market.Centene Corp. in January finalized its acquisition of WellCare Health Plans, creating what it calls the leading healthcare enterprise focused on government-sponsored health care programs. It now provides health care to more than 24 million members across 50 states.“The bigger the payers get, the more control of the market they have,” said Craig Douglas, vice...

Centene, managed care, WellCare

Read Full Articlered right arrow icon


Centene, WellCare merger finalized

January 24, 2020HME News Staff

ST. LOUIS - Centene Corp. has completed its acquisition of WellCare Health Plans, creating what it calls the leading healthcare enterprise focused on government-sponsored healthcare programs.Centene now provides health care to more than 24 million members across 50 states, or one in 15 people across the nation."We are pleased to have completed this transformational acquisition to create a leading healthcare enterprise committed to helping people live healthier lives through access to high-quality...

Centene, M&A, managed care, merger, WellCare

Read Full Articlered right arrow icon


Monroe Wheelchair works system

October 29, 2019Liz Beaulieu, Editor

SYRACUSE, N.Y. - With the rise of managed care organizations in Medicaid, especially in New York, it's been worth it for Monroe Wheelchair to have a contract relations manager on staff, Doug Westerdahl says.The company hired Rachel Herzog, who previously worked for a number of MCOs, for the role about two years ago.“I did it personally for years, but it got too much for me,” said Westerdahl, president. “She's on top of this stuff right away.”MCOs manage 83% of the Medicaid...

managed care, medicaid, monroe wheelchair, payer relations

Read Full Articlered right arrow icon


Auditors avoid appeals process, make 'major' requests

September 13, 2019Liz Beaulieu, Editor

YARMOUTH, Maine - If you're an HME provider trying to appeal a denial by a managed care payer, it's probably not going very smoothly, reports consultant Wayne van Halem.“There's a process for appeals they have to follow that's outlined in the managed care manual and they're not doing that,” said van Halem, president of the van Halem Group.The process is similar to Medicare's: a number of levels of appeals, including redetermination, reconsideration and administrative law judge or ALJ.Instead...

audits, managed care, Wayne van Halem

Read Full Articlered right arrow icon

Also Noted

Payer Relations Council sets agenda

September 5, 2019HME News Staff

WASHINGTON - AAHomecare's new Payer Relations Council met for the first time in Arlington, Va., last week, to establish objectives for 2020, including educating the payer community on the value of HME. “There is a great opportunity for the HME sector to help lead efforts to deliver comprehensive quality care, while achieving overall cost savings across the healthcare continuum,” the association stated. “The council will spearhead efforts to educate payers, policymakers, providers,...

aahomecare, managed care, medicaid, Payer Relations Council

Read Full Articlered right arrow icon


MCO bill becomes law in Kentucky

April 5, 2019HME News Staff

FRANKFORT, Ky. - Kentucky Gov. Matt Bevin has signed into law a bill that streamlines DME regulations and reimbursement policy for the managed care organizations managing the state's Medicaid program.The bill ensures that MCOs:Reimburse DME suppliers by at least 90% of the rate set by the Kentucky Medicaid program;Requires that specialty items not listed on the current fee schedule be reimbursed at the manufacturer's suggested retail price minus 18% or at invoice cost plus 20% when there is no MSRP,...

Kentucky, legislation, managed care, protections

Read Full Articlered right arrow icon

Medtrade Spring

Medtrade Spring preview: Don't get 'railroaded' by MCOs, says speaker Pam Colbert

March 29, 2019Tracy Orzel

LAS VEGAS - Now that Medicare and Medicaid are turning to managed care organizations (MCOs) more and more to cut costs, HME providers must be vigilant to make sure they get a fair deal, says Pam Colbert, an attorney with Brown & Fortunato. HME News recently spoke with Colbert, who is hosting two sessions at Medtrade Spring this year related to MCOs, about what providers need to know to play ball in this market and how to get paid.HME News: What are we dealing with here: How many Medicare and Medicaid...

Brown & Fortunato, managed care, medtrade spring, Pam Colbert

Read Full Articlered right arrow icon