Providers cite frustration with CareCentrix

HARTFORD, Conn. - HME provider complaints with CareCentrix came to a head recently, when The MED Group reportedly cancelled its payer agreement with the company.

Those complaints include improperly denied claims, low reimbursement and poor customer service.

“I've been doing this for 30 years,” said one provider who asked not to be named. “They are difficult to work with and they have so many layers in place that you cannot talk to people if you call there.”

CareCentrix manages post-acute care, including home health, HME, home infusion and sleep management, for health insurers like Cigna, making it a middleman of sorts between those insurers and providers.

Both CareCentrix and MED Group said they couldn't comment on the agreement, but several providers confirmed the change.

“CareCentrix went to the providers that were contracted through MED Group and offered us contracts individually,” said Frank Trammell, CEO of Matthews, N.C.-based Carolina's Home Medical Equipment, who held one of those contracts for several years. “The fee schedule is absurd. I said, 'Thanks, but no thanks.'”

That fee schedule, which providers say is well below Medicare's, comes on top of numerous prior authorization requirements and long wait times to get paid.

“You have to have an authorization for everything from Kleenex to Group 3 wheelchairs,” said Case Horton, director of operations for Tanglewood Medical Supplies in Stephenville, Texas, who stopped contracting with CareCentrix about two years ago. “Then it takes them 45 to 90 days to pay you. It's not worth your while.”

Other providers say CareCentrix makes arbitrary changes to their policies, then doesn't reflect them in their contracts and doesn't communicate them to providers. One provider, for example, is getting paid for only six months for items on 10-month rental contracts.

“There's been no contractual amendments, no correspondence,” said Tyler Riddle, vice president of Albany, Ga.-based MRS Homecare. “All of a sudden, they stop paying at six months. They are categorically denying claims after six months and when you appeal, they say they are only paying for six months.”

Some providers wonder why a company like CareCentrix is even needed.

“It's an unnecessary step and expense,” said Trammell. “The patient is getting squeezed, the DME is getting squeezed. Everybody is getting squeezed.”

CareCentrix responds

Although HME providers have lodged a number of complaints about CareCentrix, turnover in the company's network is low, with more than 90% remaining in-network for at least three years, says Steve Wogen, chief growth officer.

Two major complaints that providers have with CareCentrix: low rates and slow payment. While Wogen says he can't speak to the specifics of any contracts, CareCentrix continuously monitors its rates to make sure they're competitive.

“We leverage industry benchmarks from regulatory agencies, the federal government, area agencies and local Medicaid programs where relevant,” he said. “Then we negotiate in a fair, frank and honest manner with every provider in our network and every rate is contractually agreed upon.”

CareCentrix also pays 98% of its claims within 20 days, Wogen says. For claims that take longer, providers usually haven't submitted them properly or haven't followed the authorization process properly.

“We proactively monitor providers that have repeated issues with payment,” he said. “If they need additional training, we will work with them collaboratively to get that done.”

At the end of the day, CareCentrix values its relationships with providers and believes, by working together, that they can better reposition the home as the center of health care, Wogen says.

“As the patients age and there continue to be cost pressures, the ability to better leverage the home is going to be more and more critical,” he said. “We need to work with our providers to be a strong and committed partner to them.”