Session Details

Name
[PANEL] Medicare Advantage and Third-Party Administrators: Challenges Facing DME Suppliers
Track
Billing & Compliance
Date & Time
Wednesday, June 10, 2026, 10:30 AM - 11:30 AM
Location Name
Ballroom B
Presentation

Learning Objectives

Name
[PANEL] Medicare Advantage and Third-Party Administrators: Challenges Facing DME Suppliers
Description

Approximately 54% of Medicare beneficiaries are covered by Medicare Advantage Plans (“MAPs”). This means that if a DME supplier wants access to over half of all Medicare beneficiaries, the supplier must (i) secure MAP contracts, (ii) learn how to live with MAP reimbursement, and (iii) navigate MAP requirements. Another layer of complexity arises from the utilization by MAPs of third-party administrators (“TPAs”). While the MAP is the “middleman” between CMS and the supplier, the TPA is the “middleman” between the MAP and the supplier. And while there is only minimal oversight by CMS of MAPs, there is virtually no regulatory oversight over TPAs. This program will discuss (i) the increasing governmental scrutiny of MAPs, (ii) steps the supplier can take to increase its odds of securing a MAP contract, (iii) the most important provisions of a MAP contract, and (iv) the steps the supplier can take if it is not awarded a MAP contract. The program will then pivot to discuss TPAs. Specifically, the program will discuss (i) what a TPA is…and what it does, (ii) why there is currently the absence of regulatory oversight of TPAs, (iii) steps a supplier can take when a TPA takes actions that are harmful to the supplier, and (iv) steps that some states are taking to reign in TPAs.

Proposed Learning Objective (1)
Identify and outline the key steps a DME supplier can take to improve their likelihood of securing a Medicare Advantage (MAP) contract, including at least two actions that strengthen competitiveness.
Proposed Learning Objective (2)
Analyze the most important provisions of a MAP contract and explain how those provisions impact supplier participation, reimbursement, and operational decisions.
Proposed Learning Objective (3)
Define the role of a third-party administrator (TPA) by explaining its functions within the MAP contracting process and its impact on supplier-provider relationships.
Proposed Learning Objective (4)
Apply appropriate response strategies to scenarios in which a TPA takes actions that negatively affect a DME supplier, identifying at least two steps to protect compliance, revenue, or contract position.

CEU and CEC

When applicable, the CEU or CEC credits for each accrediting body are displayed below.

ABC CEU
1.0
BOC 1 CEU
0
BOC 2 CEU
1.25
AARC CEU
1.0
CEAC CEC
1.0
IACET CEU
0.1
SHRM CEU
0
Contact Hours
1.0