CareCentrix Modifies Co-Pay Collections Policy

After AAHomecare encouraged it to modify a stricter policy, CareCentrix shares rule revisions for payments made to PAP providers with outstanding balances.

• By David Kopf
• Feb 06, 2020

After payer relations outreach from the American Association for Homecare, CareCentrix has shared details on how it will modify a previously released payment policy for 2020 that would have impacted providers of sleep therapy equipment and supplies, as well as their patients.

Earlier, CareCentrix implemented a policy starting on Jan. 1 that withheld payments to providers with PAP and PAP supply patients that had co-pay balances of longer than 180 days. AAHomecare registered concerns with CareCentrix regarding the policy and asking for details on the scope of how it will impact providers and patients.

CareCentrix then provided potential impact reports for individual providers and is offered one-hour online training sessions to help them understand and adapt to the policy change. CareCentrix also shared information on patients that will be impacted by the policy change.

After reviewing that information, the Association encouraged CareCentrix to modify, and CareCentrix informed the association that it planned to make the following modifications to its suspension policy:

• PAP Rentals – If a patient’s account is not suspended prior to the initial rental of PAP equipment, then rental, PAP repair, and PAP replacement payments will not be interrupted. CareCentrix requests providers temporarily suspend PAP supplies until patients establish payment arrangements and will not provide authorization for these supplies.
• The suspension policy will not affect patients who are on other life-sustaining services, such as oxygen. CareCentrix will develop and share a complete list of corresponding HCPCS codes.
• Notification of suspension will be shared through the HomeBridge provider portal. Effective March 17, providers will be notified during the authorization process in real-time if the patient is in a suspension state now or in the past. Effective in April, real-time notification during the authorization process will be expanded to include patients with a future suspension date. Additionally, Providers can download a list of patients flagged for suspension with suspension dates at least 60 days in the future through HomeBridge.

In a public statement, AAHomecare noted that it appreciated that CareCentrix had “given serious consideration" to feedback on the original policy change's impact on patients and providers, and had "worked to reduce these impacts.” However, the association maintained that payments for PAP supplies should not be interrupted for patients with co-pay balances. AAHomecare added that it would continue to engage CareCentrix on that point.