TPA Limits
In today’s hearing aid market, almost one in five patients get their devices from a third-party administrator (TPA). Audiology professionals can’t ignore how managed care plans like these may affect business if they wish to remain profitable. Though they may initially present a lower price tag to customers, these plans only purchase the device and do not offer the substantial benefits of the continuum of care model in a traditional direct-pay treatment plan.
Along with big-box channels and other managed care options, third-party administrators represent approximately 40% of all hearing devices on the market.
- These plans also present several difficulties to practices.
- Because the audiologist is only paid the fitting fee in these instances, reimbursement is lower.
- Additional TPA-related paperwork and processing can overprioritize employees’ time. TPA patients should be carefully integrated into your practice’s schedule so that timeslots for self-pay patients are available.
How Fuel Helps: We’ll partner with you to help you navigate this evolving audiology market. Our TPA team specializes in determining the most effective way for your practice to work with TPAs to ensure you remain successful. Using contract review and advisement, scheduling adjustments and employee training, you can take advantage of existing TPAs while our Access Hearing program provides an additional treatment option for patients that doesn’t compromise ongoing care and service.
TPA Contract Advising
Fuel provides contract review advisement to make sure you understand TPA contracts and defined benefits.
What Do Your Contracts Cover?
Starting with understanding—we can review your contracts to determine which services are and, more importantly, which services are not covered.
Commonly covered:
- Testing
- Fitting
- Follow-up
- One year of service
Cleverly left out:
- Device reprogramming
- Receiver replacement
- Redux drying
- Ear cleaning
- HIT box testing Cognitive screening
If a practice provides services outside of the contract and doesn’t charge the patient directly for non-covered services, then the revenue loss is at the hands of the practice rather than the contract.
Every contract is different, so you’ll need to decide if you want to participate based on the reimbursement and what you’re required to do for the patient to get that reimbursement. Our team will empower you to make the informed decision that’s best for your practice.
How Fuel Helps: We’ll make sure you understand the TPA contracts you’re being presented with and choose the options that will best serve your practice.
Keeping TPA Patients (through access hearing)
Fuel Medical created the Access Hearing Discount Program as a supplemental strategy for practices that have opted not to accept TPA plans. Access Hearing allows you to offer a full range of services that are accessible to all patients.
Access Hearing is not affiliated with any insurance plans. Instead, our team has contracted with manufacturers directly to allow practices to provide patients with a high-quality and affordable alternative to TPAs.
Use Cases:
- Offer patients a full line of high-quality, private-label product offerings
- Offer patients robust service package options
- Allow the practice to provide extended service contracts
How Fuel Helps: We’ll partner with you to calculate the long-term ROI of a customized service contract with a patient that effectively covers the middle ground between what TPA patients have covered versus what they don’t. We also provide collateral education development for your custom Access Hearing plans.
TPA Toolkit (metrics)
If you’ve opted to work with TPAs, the most effective strategy is based on your practice’s revenue.
- For practices with a lower annual clinical revenue and schedules a week out, TPAs are an avenue for new patient acquisition and a means to increase profits.
- If annual clinical revenue is moderate and practice maintains two weeks of scheduled patients then block scheduling can be a beneficial way to assign TPA patients to slots that are typically less sought-after by self-pay patients.
- When clinics generate higher revenue and schedules are filled for about three weeks or longer, the emphasis can switch to self-pay patients and referrals from physicians. They may also choose to opt-out from the TPA network.
In today’s market, it’s not viable to offer your services without charge and still hope to maintain your practice. There’s no need to lower your service quality, but it’s important to educate patients and request payment for non-covered services.
Developing a solid strategy to manage TPA patients effectively while still providing them with the option of the medical model of care is key to keeping your patients’ hearing and your practice’s finances healthy.
How Fuel Helps: We’ll help you determine which strategy will work best for your practice and assist in its implementation.
Block Scheduling
This type of scheduling allows practices to create dedicated appointment blocks for TPA patients and patients with traditional insurance.
Use cases:
- Ensure sufficient time is set aside for the appointments that bring the most revenue to your practice.
- Ensure enough coverage is provided to service the medical needs of the patient population.
- Ensure your practice doesn’t lose money by having too many appointments that are of low or no revenue.
A study by the University of Colorado Internal Medicine Residency Program found that block scheduling led to reduced burnout in residents.
Blocks will vary in length and frequency depending on your practice needs. We can help you determine your practice’s needs by conducting a three-month schedule assessment.
How Fuel Helps: We’ll guide you through block scheduling for your practice. From determining how much time is needed per block to determining the value of each block and effectively scheduling them to maximize your ROI—we provide a full-service solution to block scheduling integration.