Medtrade preview: Joshua Skora on implementing a payer playbook

DALLAS - When it comes to payer relations, success depends on the strength of your relationships, says speaker Joshua Skora. 

Here’s what Skora, a health care regulatory attorney with K&L Gates who will be speaking on a panel at Medtrade titled “Building Relationships with Payers,” had to say about how both parties can benefit from successful relationships. 

HME News: What are the priorities of commercial payers? 

Joshua Skora: Commercial payers are concerned with balancing the need to provide health care services to their beneficiaries with the need to reduce the risks and costs associated with poor and/or medically unnecessary treatment. 

HME: How can providers use this knowledge to their benefit? 

Skora: Understanding these priorities, providers can take several steps to increase the likelihood of payment for services rendered. For example, providers can develop and maintain policies and procedures that ensure medically necessary, high-quality patient care. Additionally, providers can utilize billing and coding staff to increase the accuracy of providers’ processes for documenting, coding and submitting claims to payers. 

HME: What's an example of a collaborative opportunity between payers and providers? 

Skora: Increased transparency between providers and payers, as it relates to the provider’s services and the payer’s monitoring efforts. Payers and providers can work together to develop mutually beneficial ways to share clinical and claims data and agree on how such data will be analyzed. Additionally, implementation of capitated fee structures aligns the goals of payers and providers to efficiently provide medically necessary health care services. 

HME: How do you see partnerships between providers and payers evolving in the future? 

Skora: With increased transparency and collaboration on how and when health care services are provided, providers can focus less on preparing for payer audits/investigations, and more on the provision of the health care services. 

The details 

When: Tuesday, March 26, 2:15 PM - 3:15 PM 

Where: Room: D170/172