AAH boosts rate strategies with new portal

WASHINGTON – AAHomecare’s new Payer Transparency Portal is another tool for the HME industry to fight low reimbursement rates from commercial insurers, says Laura Williard. 

The portal, which is free to AAHomecare members, features data from more than 60 major commercial insurers, helping providers to understand payment rates and trends. 

“They can use the data to see where they are in the percentiles and build their story on what programs and processes they have to improve outcomes,” said Williard, senior vice president of payer relations for AAHomecare. “This will help them tailor their discussion on maintaining rates or increasing rates and prepare talking points for whichever scenario they fall into. Prior to having this data, they may have been asking for increases where payers would not see a need (for it).” 

AAHomecare developed the portal in partnership with Medlyze Technologies, a New York-based company that analyzes price transparency data published by health plans and hospitals in machine-readable files. 

While the data in the portal is publicly available through CMS’s “Transparency in Coverage” final rule, AAHomecare has worked with Medlyze for the better part of a year to put the “terabytes upon terabytes of data” into a more consumable format. They also worked to winnow it down into “true, real data,” Williard says, eliminating, for example, oxygen rates for skilled nursing facilities. 

“You can put in a code or category of codes like sleep and look at the rates from a national perspective, regional perspective or bid region, or state perspective,” she said. “You can see the minimum, maximum and average rate. You can see there are 24 tax IDs in Ohio that have this rate for these items.” 

The portal also contains Medicare fee-schedule rates and later this year it will also include state Medicaid fee schedule rates, Williard says. 

“We feel like having this data readily available (in one spot) will save providers a lot of time,” she said. “We hope they will embrace it.”  

AAHomecare, which is hosting a free webinar on Jan. 30 to walk members through the portal, is also offering providers a discount code for more advanced services from Medlyze. In turn, the association will receive profit sharing that it can put toward advocacy efforts.