Tag: Steve Selbst
Five ways to break down bureaucracies to get payer contracts
July 25, 2019Guest Commentary
It is important to remember that payers are large companies, with protocols, policies and business practices. As with any large company, there are bureaucracies, and they are necessary to maintain the order and success of these organizations. Therefore, the first tip is to understand that to get contracted you need to identify the right department and right person to send your request to get contracted. This is usually the payer contracting department and payer contracts' manager. Generally,...
Three key items to negotiating successful payer contracts
June 26, 2018Guest Commentary
The purpose of this article is to help you, as a provider, to hone in on three key items to look for in payer contracts that will help you to get profitable contracts in place. The three key areas that we will examine are fee schedule amendments, lesser of billed charges vs. contracted rates; term and termination without cause; and claims' payments.Fee ScheduleFee schedules sometimes are RVU based or based upon a percentage of Medicare or based on a percentage of a payer's proprietary fee schedule....
Contracting: Understand different programs
January 3, 2017Steve Selbst
A. Most HME providers understand that the Department of Veterans Affairs provides healthcare services nationwide for America's veterans and that in addition to having facilities across the country, the VA has additional methods to provide timely, high quality care to veterans.What providers may not understand is that there are three contracting options available to them. First is Patient-Centered Community Care (PC3), a program for active duty, retirees and their families, that increases access to...
Contracting: Set your chargemaster
November 30, 2016Steve Selbst
A. One of the most common and often misunderstood potential hazards in payer contracts is the “lesser of billed charges” language found in almost all contracts. This language is usually worded like this: “Health insurance company will pay provider the lesser of its billed charges or its payer contracted rates for each code's reimbursement.” What does this mean exactly?It means that, for example, if your payer-contracted rate at 100%, including patient co-payment, is $110 for...
Contracting: Beware these contract pitfalls
October 21, 2016Steve Selbst
A. In addition to contracted rates, there are key items often found in payer contracts that can significantly affect and often reduce reimbursements. Here are a few to look for:• Retrospective review. Watch out for clauses limiting the amount of time the payer can review paid claims for mistakes (and overpayments). A time limit for a retrospective review could prevent you from having to pay for indefinite claims errors on the part of the payer.• Termination for cause. You want...
Contracting: Offer best value proposition
September 29, 2016Steve Selbst
A. It is often challenging for HME companies to get contracted with payers. Payers often close their networks to new provider applications once they reach a certain number of HME companies. There are two similar scenarios: a closed network and a narrow network. When a network is closed, the payer has established a business practice that it is not accepting more providers into an existing network. In a narrow network, the payer has determined that it is generally not accepting more providers...
Healthcents makes sense of managed care
February 5, 2016Liz Beaulieu, Editor
SALINAS, Calif. - Healthcents has watched as HME companies—not only providers, but also distributors and manufacturers— have become 60% to 70% of its customer base, replacing the medical practices that were the bulk of its business 10 years ago. “We're seeing acceleration in the DME space because these companies are looking to expand their revenues by contracting with health insurance companies, whether it's in the form of GPOs, formularies or PMBs,” says Steve Selbst, CEO...