The insurance market can be complicated and difficult to navigate, especially for independently owned facilities with limited resources. In this situation, a provider network can simplify the process of acquiring insurance contracts and potentially reduce the administrative and financial burdens for independent providers.
The Prosthetic and Orthotic Management Associates Corporation (POMAC) is one such network. Founded in 1993 and based in Mount Laurel, NJ, POMAC was established in response to the demand from insurance companies to deal with networks.
“POMAC was started 20 years ago by three business owners who were clinicians,” Jon Shreter, CPO, LPO, executive director of POMAC, told O&P Business News. “The insurance companies that managed care wanted to deal with networks as opposed to individual providers. The owners started this organization so that the insurance companies would have one-stop shopping.”
Michael Mangino, CPO, CPed, LPO, the owner and founder of Bay Orthopedic in Huntington, NY, has been a POMAC member since the early 1990s.
“They had a really good plan regarding managed care. POMAC was going to act as a shield, which they did, and still do, and allowed us to stay viable,” Mangino said. “And POMAC is run by practitioners who actually understand what you are doing vs. other networks that are run by business people.”
Today, POMAC comprises approximately 130 independently owned and operated O&P and durable medical equipment offices across the United States. A centralized management and administrative staff operate out of the Mount Laurel office, which represents the single point of contact for both insurance companies and POMAC’s provider members.
“Insurance companies are looking for networks to help them, because when they deal with a network, it takes some of the administrative burden off of them and makes them more efficient and profitable, too,” Shreter said.
In order to reduce administrative and operational costs, POMAC utilizes contracted billing resources.
“We have limited our fixed expenses and contracted the billing out so we only have to pay on an as needed basis,” Shreter said. “This has reduced a lot of the overhead.”
The outside billing company, which has three staff members and a manager dedicated solely to POMAC members, handles all claims, which reduces the administrative strain for members and enables providers to spend more time on patient care.
“It cuts through all of the red tape,” Mangino said. “It reduces all of the time it would take for you to do your own marketing and researching the correct people to call for various tasks. And a lot of it is done with online capabilities now.”
Shreter also attributes POMAC’s success to the use of the Internet. Often, insurance companies will instruct patients to visit its website for a comprehensive list of approved providers, which usually includes a POMAC provider member.
“As a result, the POMAC office doesn’t have to filter out as many referrals anymore because most of the patients contact the facility directly through the website,” Shreter said. “So [the referral process] has become a lot more efficient thanks to the Internet.”
According to Shreter, one of the main benefits of belonging to a provider network is an increased access to insurance contracts.
“There are insurance companies that don’t want to deal with an individual provider in O&P; they want a network,” Shreter said. “So for independent providers that can’t get their own contracts directly with an insurance company, if POMAC has that contract and the provider is a member, they can take care of their patient’s through POMAC’s contracts.”
This also enables providers to grow their patient base, because they are able to accept a wider range of insurance plans.
“We are seeing patients from doctors that we would not normally have a relationship with,” Mangino said. “That has been great for us, because it allows us to open doors to meet new doctors.”
Becoming a member
To become a member of POMAC, providers must fill out an 8-page application. There are no annual membership fees, but providers must pay an initial application fee that varies by geographic region. Admission requirements are based on the standards enforced by the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) and the Board of Certification/Accreditation, International (BOC).
“If a provider is ABC- or BOC-certified and went through the process of getting accredited, that usually covers most of our requirements,” Shreter said. “They also have to have a quality assurance program. A lot of insurance companies are looking for that, and it’s very important, as well as credentials being up to date.”
POMAC also monitors its members’ credentials, ensuring that providers continually update their regulations and maintain compliance.
“It’s a nice friendly check of your credentials without being audited,” Mangino said. “And they are watching your back at the same time, which is extremely helpful.”
Although many of POMAC’s provider members are located along the East Coast, POMAC has expanded its network to the western region of the United States.
“Just like the insurance companies consolidate as they become bigger, it’s natural evolution for networks to want to become bigger to deal with the insurance companies,” Shreter said. “It’s much more efficient.”
A bicoastal presence also allows POMAC to be aware of any practice trends that may be formulating on the West Coast. To inform its members about such trends or other critical information, POMAC utilizes newsletters and emails to alert provider members and keep everyone informed and aware of the latest industry developments.
“When trends are coming in from the West Coast, POMAC knows about it,” Mangino said. “You are finding out faster. A local practitioner might not see a trend coming in, and by the time you read the article, it’s already been in practice for 2 months.”
Shreter encouraged all independent providers to consider the advantages afforded by belonging to a network.
“Instead of going through the start-up costs and trials and tribulations of starting your own network, consider POMAC to help. The bigger network we have, the better it is for providers because they have access to more contracts,” Shreter said. “There is a better chance, whether it’s through POMAC or one of our competitors, to be successful in getting a major insurance company contract.” — by Megan Gilbride
Disclosure: Shreter is the executive director of POMAC.