As HME providers begin to evaluate their 2023 contracts with payers, the American Association for Homecare has launched a Payer Engagement Resources web page that aims to help providers in their negotiations.
The association noted in a public statement that HME providers don’t have to accept a contract “as is” from a payer, especially under current market conditions.
“With increased costs in the market index, inflation index, and other challenges, this is a pivotal time to negotiate your individual contract while payers are looking at fee schedules for 2023,” the statement read. “Do your payers understand the value of your services to their patients/members?”
The Payer Engagement Resources page includes:
- A letter that providers can send to many major commercial payers to educate them on the challenges of providing DME in today’s marketplace. The letter incorporates many facts relevant to the cost increases that are occurring in the market.
- A letter for educating payers on the current enteral nutrition market environment in light of the PHE, major recalls, and supply chain challenges. There are many product-specific resources to help with your conversations.
- Negotiating Managed Care Contracts Whitepaper.
AAHomecare also offered some tips on negotiating with payers:
- HME providers should read contracts entirely or have legal counsel review them.
- Providers should have specific requirements and requests in mind when negotiating with payers, and they should have data specific to their company to back these up.
- Tell a story that helps explain what a day in the life of your patients is like when being cared for by your company.
- Payers might find it helpful to segment your product offerings by category (i.e. respiratory, mobility, medical supplies, etc.) to target areas where your reimbursement might need to be addressed.
- Depending on the payer’s level of HME expertise, the provider might have to explain the complexities and costs related to running an HME business.
Additionally, Laura Williard and David Chandler of the AAHomecare Payer Relations team will present “Educating Payers on the Value of DME” at Medtrade East in Atlanta on Oct. 24 from 3:30 p.m. to 4:30 p.m. Eastern time.