Letter to Medicaid Directors Regarding Incontinence Reimbursement (May 2022)
November 29, 2023
Navigating through payer relations with Commercial payers, Medicare Advantage plans, and Managed Medicaid plans can be challenging for HME suppliers. Preparing yourself with information is always the first step prior to scheduling any meetings with these plans. AAHomecare has collected resources and talking points to use in your discussions with these payers.
Make a plan for your company to make the most of your payer negotiation meetings. Reference the Market Impact Payer Negotiation Template Presentation to help build your own story and leverage it for upcoming negotiations.
Health Industry Distributors Association (HIDA) has developed some compelling infographics with data demonstrating some of the increased costs effecting HME provider. This information can also be used to supplement your asks in individually negotiated contracts.
Medline’s Supply chain update from July 2022 also contains key statistics and data points that providers can utilize in conversations with payers they are individually contracted with.
AAHomecare has developed a letter that suppliers can use with their payers explaining the current PAP market issues and request that “insurance companies remove, for a limited period of time, any policy requiring patient compliance data for continued use or authorization” in order help maintain patient access to PAP devices. Suppliers looking to utilize PAP devices with limited data tracking/sharing capabilities can download the letter here.
AAHomecare has also developed a letter focused on educating payers on the current enteral nutrition market environment in light of the PHE, major recalls, and supply chain challenges. The letter also specifically requests payers to waive prior authorization requirements for enteral nutrition, fast-track product additions to approved formularies, and to consider adjusting reimbursement to accommodate inflation and other added costs. You can download the letter here.
More resources related to the HME industry’s current market environment can be found on AAHomecare’s Resources page including:
AAHomecare’s Reports & Studies page contains compelling research that HME providers can share with commercial payers they are individually contracted with including:
Our research estimates that 37% of suppliers have gone out of business or been purchased since 2013. Use this data to show the impact to your state and service areas. Also, use supplier specific stories for your states to make the biggest impact.