Payer Relations: Establish a point person

Q. What is payer relations and why is it so important?

A. You may have contemplated this question and wondered why many companies are putting so many resources into this area. Simply put, payer relations (also referred to as payor relations by some) describes operations that work with a range of third-party payers to make sure patients have access to high quality equipment and care. 

Payer relations goals can be accomplished in three general ways: by working directly with insurance companies, advocating for regulatory change through a governing body, and by advocating for legislative change. Your state, regional and national associations have access to payer relations experts who can assist with this process. When problems arise, you need a point person to work with the payer and find solutions that allow you to continue servicing patients and be paid appropriately. This staff should also be able to articulate problems and identify solutions to government personnel and elected officials who can enact regulatory or legislative change that will prompt payers to operate more consistently and fairly. 

Dedicated payer relations professionals are typically individuals with a strong understanding of billing technicalities and able to find high-level solutions that will not hurt an organization's bottom line. They also need solid analytical skills and the ability to compare various fee schedules with HME provider's fixed and variable costs. 

The HME industry was built on keeping patients healthy in their home as opposed to more costly institutionalized care options. However, this model is not sustainable if we are not paid appropriately and in a timely fashion for our service. Payer relations professionals work to ensure patients in need continue to have access to quality equipment and care in their homes. 

David Chandler is director of payer relations for AAHomecare. Reach him at davidc@aahomecare.org.