Providers cite frustration with CareCentrix

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Friday, December 21, 2018

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.”

Comments

We had a contract with them for several years.  Nothing but problems.  It came to ahead when they gave us an auth for a group 3 chair.  A year later they tried to recoup the money because Cigna denied it.  After many phone calls, it turns out they never submitted to Cigna for auth.  So we said no thanks, we won't give you your money back for your screw up and never resigned a new contract.  

We had a contract with them, but when it came to getting paid, they play every trick in the book to deny payment.  I have been in this business for over 20 years and have never worked with a company so incompentent.   They take no accountability, pass the buck where ever they can and blame it on the providers.  They get paid by the HealthPlan and they don't pay their providers.  

We signed a contract with CareCentrix many years ago. We had so many issues with authorizations getting lost, incorrectly done, and ultimately never getting paid. We eventually canceled our contract. We lost lots of money is denials. We even had provider specialists help us to resolve issues and they still could not get them paid. CareCentrix would authorize supplies and the Home plan would deny and they would not pay or even pay and then recoup the money up to 6 months later. The time and man power it took to fight them eventually went over our profits. When asked I warn providers to not contract with them.