Thursday, July 6, 2017

Stemming the Tide Through Payer Relations

As reported in Wednesday in Washington, AAHomecare remains focused on legislative and regulatory strategies to move the industry forward. But our investment in payer relations has also produced impressive returns for HME providers in our first year focusing on this area.

“With increasing pressure to save money on state budgets, it’s critical that we have a strong capability to help respond to proposed Medicaid rate cuts and rally providers and state associations to advocate for fair reimbursement policies,” explains Tom Ryan, AAHomecare’s president and CEO.

In just one year, AAHomecare has been successful in stemming the tide and in some cases reversing further cuts with the help of state associations, utilizing a multi-pronged approach. Here are just a few results:

  1. With the aid of AAHomecare’s Dobson DaVanzo Study which analyzes the full operational costs plus cost of goods against the current Medicare reimbursement environment, the industry has effectively negotiated pricing agreements for DMEPOS providers with state and national payers. 
  2. The Association consulted with legal staff on how the CURES Bill impacted TRICARE, Medicare Advantage, and Managed Care payers. AAHomecare provided a reference for the industry to use in discussions with payers on getting July-December 2016 claims reprocessed. The Association also worked with Brown & Fortunato to obtain legal opinion on the rights and responsibilities of the states in implementing CURES language.
  3. Over the course of the year, AAHomecare has built relationships with many private payers that directly impact the health of our industry and future reimbursement decisions. On the national level, payers included Anthem, TRICARE, the Defense Health Agency, AIM Sleep Management, and Carecentrix. We believe these relationships will build to greater impact on policy and operational changes for HME providers.
  4. At the state level, AAHomecare has worked with regional associations to secure wins in several states who were following suit with Medicare reimbursement. These include working with NEMEP to secure a freeze of current rates until further notice with the New York Medicaid Incontinence Program. AAHomecare also joined Big Sky Association of Medical Equipment Suppliers to evaluate strategy and create a white paper for presentation to BCBS Montana regarding reimbursement cuts to the 2017 fee schedule. Further, in conjunction with the Maryland-National Capital Homecare Association, AAHomecare worked to establish a strategy for fighting pricing cuts with DC Medicaid. We have received notice the Agency is evaluating the information given and analyzing the budget before finalizing decisions, but expect changes to be made.

Williard Elevated to Vice President Role

These efforts on behalf of AAHomecare have been led by AAHomecare’s Laura Williard, who the Association has just promoted to Vice President of Payer Relations. “Laura Williard has brought significant expertise and energy to her role as leader of our payer relations efforts,” said Ryan. “She has gained a great deal of credibility with HME providers and has established solid relationships with state healthcare stakeholders and other major payer organizations.”

You can read a more extensive review on payer relations efforts and the work of Laura Williard here.

Laura can be reached at – and follow her on Twitter: @WilliardLaura.

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