Behold the Payer

There is much to learn when embarking on a successful HME sales career. Learning how your operations department functions, the product lines you offer and the needs of the referral source are just the beginning. The key is selling products that generate income for your company and, ultimately, yourself.

That’s something we must focus on if we are going to survive these difficult economic times. We are often concerned about the price the competition has set for the same product. We wonder if supply and demand make a difference in how we should price our products. We consider as well what price the marketplace might bear.

These are all interesting business concepts, but do any of these economic issues play a role in the home care industry? Some do, but most pricing issues we must deal with come handed down to us from a third-party payer. We often have little understanding of the formula for price-setting, nor are we at liberty to alter the price due to local trends or the economic environment.

Now that that has been clarified, what’s a salesperson to do? The best we can do in order to be successful and profitable is to understand as much as possible about the payer, the payment and the process we must follow in order to get paid.

In fact, it’s all about the payer. Too many salespeople see their role as one related to making the phone ring, creating orders and locating new referral sources. Today, that may not be enough. In some companies the phone is ringing, but too often without the right type of order on the other end of the line.

What must a salesperson learn before he or she moves out to capture the right business in the marketplace? Competitive bidding and the present reimbursement environment make learning about products and payers even more important. Here are some strategies and tasks to consider:

• Make a list of contracts you have with any managed care groups or payers. You want to know who is paying what for what. You could find that some products or services have been excluded in some contracts. There could be products that are not covered at all, and for those, the patient might need to make a cash purchase. Take a look at each primary payer source and become familiar with the profits you get from the particular products you provide. You are not in business to break even; you are in business to make a profit. You cannot, as a salesperson, consider making a commission on the sale of products that do not generate a profit for the company.
• List all the third-party payers you work with, and note those you do not or might not want to. If this information changes, make sure you are notified immediately. You don’t want to tell a referral source you accept a certain insurance when your agreement with that payer has been cancelled.
• Learn about the types of patients your referral source works with primarily. If the source has a caseload of Medicaid patients and your product line is not covered by the state’s Medicaid plan, for example, you should know this information.
• If it is at all feasible, get to know the payers your company works with and any payer representatives who might authorize or even deny your payments.
• Often insurance companies employ case managers to work on their more complex and difficult cases. While it may not be easy to meet these people in person, find out whether the payer contracts with any independent case management companies that might be located in your community. Nothing beats a face-to-face meeting with the person who can authorize payment or challenge an order. As a salesperson, this connection could prove invaluable. You might learn that with specific documentation, what was originally denied could now be listed a covered item. Sometimes contracts do not have all the rules outlined, and some can be discovered only through a face-to-face meeting.

“Sales” is about just that — sales. The problem is that while the sale might take place, the profit could be missing. You must make sure that your sales are profitable. If they are not, find out why. We all understand there is value in helping to solve a problem because of the seriousness of the need rather than our need to make money. But we are not a charity. The time has come to get to know your payers, inside and out.

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Louis Feuer is president of Dynamic Seminars & Consulting Inc. and the founder and director of the DSC Teleconference Series, a teleconference training program. You can reach him through www.DynamicSeminars.com or at 954/435-8182.