Page 32 - HME Business, October 2019

START CLIMBING THE MANAGED CARE LEARNING CURVE
Jeff Baird, Esq., chairman of the Health Care Group at law firm Brown & Fortunato, P.C.
Providers must learn how to deal with third-party payers, and in particular commercial insurance companies that sponsor Medicare Advantage plans and Medicaid Managed Care plans. (In fact, this is a topic that Baird,
recently spoke on for “Managing the Manage Care Opportunity,” an HME Business webinar that is available as an archive at hme-business. com/webinars.)
Managed Care is quickly becoming part
of everyday business for HME providers. Approximately 35 percent of Medicare benefi- ciaries are signed up with Medicare Advantage Plans, while roughly 70 percent of Medicaid beneficiaries are signed up with Medicaid Managed Care Plans. Moreover, these percent- ages are increasing.
“Over the last 10 years or so, the DME industry understandably has been focusing on what to do with competitive bidding, what to do with post payment audits, things of that nature,” Baird
says. “And the industry just didn’t pay any atten- tion to the growth of Medicare Advantage plans and Medicaid Managed Care plans, and they snuck up on us.
“And all of a sudden, we as an industry, we’re finding out that more and more of our patients are being serviced by these insurance compa- nies, and if we’re not in network, then we can’t take care of the patients, and that’s a problem,” he continues explaining. “And so I see as a big challenge for us as an industry is to understand how Medicare Advantage works; understand how Medicaid Managed Care works; under- stand how to have the best chances of being admitted to the supplier panels sponsored by the Medicaid Managed Care plans and Medicare Advantage plans. And then after that, can we live with the reimbursement that they pay?”
Baird notes that the challenge of obtaining, negotiating, working with these insurance companies is foreign to most of DME suppliers, because it has not been in the DME space until just recently. That means providers don’t have much experience in terms of working with these third-party payors. That said, it’s not rocket science and the work pays dividends.
“Once a DME supplier is on a panel and has
signed a contract with a third-party payor, then it is a lot easier working with that third-party payor than it is working with traditional Medicare or traditional Medicaid,” he explains. “So, it’s actually simpler working with these commercial insurance companies.”
INSTALL AN ‘OPERATING SYSTEM’
Ty Bello, president and founder of Team@Work
When it comes to juggling multiple payers, maximizing multiple revenue streams, and yes, still trying to make the most of Medicare and Medicaid opportunities, providers need to implement management prac-
tices that help them flexibly manage all that. Specifically, Bello says providers need to start
thinking about an “operating system” for their businesses. And it turns out they don’t have to start from the ground up — there are some proven systems of strategic business manage- ment that apply to HME.
“There are multiple systems that are out there and many people have heard of these,” he says. “They’ve heard of Traction which is an entrepre- neurial operating system. They’ve heard of the
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