Medtrade Spring preview: Don't get 'railroaded' by MCOs, says speaker Pam Colbert

LAS VEGAS - Now that Medicare and Medicaid are turning to managed care organizations (MCOs) more and more to cut costs, HME providers must be vigilant to make sure they get a fair deal, says Pam Colbert, an attorney with Brown & Fortunato. HME News recently spoke with Colbert, who is hosting two sessions at Medtrade Spring this year related to MCOs, about what providers need to know to play ball in this market and how to get paid.

HME News: What are we dealing with here: How many Medicare and Medicaid beneficiaries do MCOs cover?

Pam Colbert: In 2019, 22.6 million or 36% of Medicare beneficiaries were enrolled in a managed care plan. The estimated number of Medicaid and CHIP beneficiaries enrolled at the end of 2018 was approximately 54 million individuals.

HME: How can providers make sure they get a fair deal when working with MCOs?

Colbert: They should work with their state associations, their federal and state representatives, CMS and their state Medicaid legal department. Beneficiary testimonials are the best, strongest tool they have. And then there are the legal options. I know not every one can afford lawyers, but that, generally, is a very good avenue, as well.

HME: What should providers look for when it comes to MCO contracts?

Colbert: They're going to be boilerplate contracts, but if the MCO tries to unilaterally alter it and say, “We're going to cut your rates and you have no rights to negotiate those rates," providers need to have a unified group, like an association. They can then file a complaint with the state agency, so the MCOs realize they don't get to just railroad over them.

HME: How do you see the MCO landscape evolving?

Colbert: I hate to say it, but I think MCOs are going to continue. There is some resistance, and at least now the states and the federal government are beginning to realize they can't trust that they'll do the right thing anymore. It's like turning your child over to daycare; you have to make sure they're really being taken care of.