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The HBMA Commercial Payor Relations (CPR) Committee plays a vital role in advocating for the interests of HBMA members in their dealings with commercial insurance companies. This committee bridges healthcare revenue cycle management (RCM) companies and major commercial payors, working to reduce administrative burdens and improve reimbursement processes across the industry. In a professional and collaborative manner, the CPR Committee is helping to simplify the medical billing/RCM industry by fostering open communication and problem-solving with insurers.
Mission and Advocacy for Members
At its core, the CPR Committee’s mission is to advocate for HBMA members and our industry by building meaningful, cooperative relationships with commercial payors. The committee strives to reduce costs and simplify administrative processes that billing companies face while helping members navigate the increasing complexities of medical billing and reimbursement. In practical terms, this means the CPR Committee brings common obstacles to the attention of insurance payors – whether, for example, it is cumbersome claim submission procedures, unclear payment policies, or inefficient workflows. By having a seat at the table with insurers, the committee gives HBMA members a collective voice to push for changes that make everyday operations more efficient and less costly.
Activities and Payor Partnerships
The CPR Committee engages in a range of activities to carry out its mission. The committee meets regularly via monthly conference calls to discuss emerging billing issues, share member feedback, and strategize on solutions. In addition, CPR subcommittees hold quarterly meetings with representatives of major payors to maintain an ongoing dialogue. Currently, the committee has active and collaborative partnerships with four of the largest commercial insurers – Aetna, Cigna, Humana, and UnitedHealthcare. During these joint sessions, HBMA’s CPR volunteers and payor representatives review pain points and updates on both sides. The open lines of communication established through these meetings allow the committee to raise HBMA members’ concerns directly with payors and cooperatively work on initiatives to resolve them. By investing time in these relationships, the CPR Committee helps preempt issues and finds mutually beneficial ways to streamline processes, from simplifying prior authorization requirements to improving provider portal functionalities.
Success Stories and Industry Impact
The CPR Committee’s collaborative approach has already led to several success stories that are making a real impact on RCM companies. One notable example is the work with Aetna. In 2023, the committee partnered closely with Aetna to develop streamlined processes that would achieve administrative simplification for RCM firms. As a result, Aetna released new resources (including an exclusive HBMA Aetna Resource Guide) and introduced process improvements that make it easier for billing companies to work with Aetna on an ongoing basis. This includes clearer guidance on claims handling and more efficient escalation paths for resolving issues – concrete improvements that save time and reduce frustration for HBMA member companies.
Another success story has come from the committee’s engagement with UnitedHealthcare. Through ongoing dialogue and feedback, UnitedHealthcare has implemented important enhancements to its digital tools that benefit RCM organizations. For instance, UnitedHealthcare introduced a new “Teams View” feature within its provider portal’s Document Library in 2023, making it simpler for RCM teams to manage client documents across multiple tax IDs. This improvement, born out of understanding the workflow needs of billing companies, helps HBMA members work more efficiently by enabling better internal collaboration on claims and correspondence. Improvements like these – achieved via cooperative effort – directly contribute to smoother reimbursement processes and demonstrate the value of having an industry voice through CPR. The positive results seen with Aetna and UnitedHealthcare are encouraging models that the committee is also looking to replicate with other payors.
Member Feedback and the Payor Reporting Tool
A key factor in the CPR Committee’s effectiveness is its commitment to listening to HBMA members. The committee actively seeks input on payor-related challenges through a special web-based reporting tool available to all HBMA member companies. This Commercial Payor Reporting Tool is a portal where members can document specific issues or recurring problems they encounter with insurers. Whether it is an increase in unjustified denials by a particular carrier or difficulties with a new portal feature, for example, members can submit their issues in this system. The CPR Committee aggregates these submissions to identify common trends and high-priority pain points. Each quarter, the committee brings this member-driven data to its meetings with payors. By presenting real examples and data collected from the field, CPR volunteers can advocate for improvements with evidence in hand. This collaborative problem-solving approach helps persuade payors to adjust policies or fix system issues since the feedback is specific and backed by multiple member reports. In short, the reporting tool empowers HBMA members to have their concerns heard, and it guides the committee’s conversations with insurers to push for practical improvements that benefit the entire industry.
Getting Involved – Join the CPR Committee
Dedicated volunteers fuel the work of the CPR Committee, and new volunteers are always welcome. Serving on the committee is an excellent opportunity for HBMA members to have a voice in the billing industry while growing professionally. Members of HBMA are eligible to join, and the time commitment is very reasonable – about one hour per month for the committee’s conference call, with occasional additional tasks as needed. Volunteers bring a variety of perspectives and expertise, which enriches the committee’s discussions and solutions. It provides an opportunity to network with peers and directly engage with payor representatives on issues that impact your business. Many find that contributing to a committee not only helps the industry but also provides valuable insights that they can take back to their organizations.
HBMA and the CPR Committee warmly encourage any interested members to reach out and learn more about volunteering. By joining, you will be part of a collaborative team that works to reduce headaches in the billing process and improve the financial health of RCM and healthcare practices. If you are interested in volunteering or have questions about the CPR Committee, please contact HBMA at info@hbma.org.
The committee is eager to welcome new members and continue its mission of advocacy and improvement. Working together, HBMA members and the Commercial Payor Relations Committee can drive positive change in our ever-evolving industry – one payor partnership at a time.
