Payer Relations Tools and Impact

Reimbursement Relief

Drastic reimbursement reductions under the bidding program and for non-bid area suppliers is decimating the HME community. The impact is now being felt with all payers. However, AAHomecare's team is employing a wide range of resources and working on multiple fronts to continue engagement with CMS, HHS, and the OMB including Medicare, Medicare Part C, Medicaid, and Dual Oversight Offices. The focus of the Association's payer relation's team is working towards relief on rural reimbursement rates that impact a broad range of payers. Advocating for fair, common-sense regulations that help put patients over paperwork, working with state and regional association leaders on Medicaid rates and other managed care payers, working with Medicaid plans and MCO plans to eliminate administrative costs for providers, and continuing to grow the resources to fight for HME interest in Washington and at the state level are a few of the ways we are making an impact. 

The strategy for Medicaid CURES has seen success. Laura Williard, vice president of payer relations, has participated in 23 state Medicaid meetings and completed ten utilization analysis as well as another seven alternate proposals with two of those being accepted and the others still pending. Thirteen states have been influenced to not make rate changes for 2018 and five states which have chosen to make rate changes have been influenced to only make changes to the 244 CURES HCPCS codes. 

COVID-19

With the advent of the COVID-19 pandemic, the Association has shared guidance for relaxing authorization and delivery requirements as well as other flexibilities with policymakers and spearheaded a sign-on letter to major commercial payers from 150 suppliers, manufacturers, and other HME stakeholders in support of our recommendations.  As a result, 34 state Medicaid programs and all major commercial payers adopted these practices or granted similar flexibilities to help suppliers serve patients safely and effectively under challenging circumstances.

CARES Act

The payer relations team also worked with TRICARE contractors and the Dept. of Defense to ensure adoption of higher rates granted in the CARES Act for the duration of the COVID-19 Public Health Emergency (PHE) and retroactive for claims back to March 6.

Medicaid and medicare

• state medicaid & medicaid managed care

• commercial & Medicare advantage

Payer Relations - Review of Activities

Payer Engagement Resources & Value of HME

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. We also offer a Value of HME brochure with resource to speak with payers about the value homecare brings to the healthcare continuum including videos for discussion and education.

What Members are Saying

“Joining AAHomecare and getting involved in some of the councils has been a great networking opportunity.  The biggest benefit has been the payer relations piece. Laura Williard was a huge help with WV Medicaid. Her expertise really helped us. Once we a meeting with WV Medicaid and Laura we were able to set up a quarterly meeting with Medicaid.  That has helped us with the transition to MCO's in our state.  Payer relations is an area we all struggle with so I think it is an awesome asset.”—Regina Gillispie (Best Home Medical, WV)