‘When it comes to Medicare, it’s never painless’

Thursday, July 31, 2008

WASHINGTON--Medicare’s new Common Electronic Data Interchange (CEDI) has earned mixed reviews from providers.

Rather than having the four DME Medicare Administrative Contractors (MACs) process claims for each of their jurisdictions, National Government Services, the CEDI contractor, now process claims nationwide.

For some providers, the transition to CEDI, which took place May 1 in jurisdictions A and D and June 6 in jurisdictions B and C, has been painful.

William Lamberson, a provider in Jurisdiction C, wasn’t able to process claims for several weeks post-transition.

“They didn’t accept our claims until last Thursday,” said Lamberson, president of Lamberson’s Home Care in Duluth, Ga., in late June. “Now we don’t know how long it’s going to take them to process the claims and pay us. We have a backlog of 276 claims. When it comes to Medicare, it’s never painless.”

For other providers, the transition to CEDI has been seamless. Kim Munsue, a provider in Jurisdiction C, believes CEDI makes her job easier, because she no longer has to rely on her DME MAC to transfer claims to other MACs when necessary.

“We’re loving it,” said Munsue, the billing department manager for Holland Medical Equipment in Nashville, Tenn.

National Government Services sent providers an update on July 9 that stated it was finishing up claims that were received May 29 and starting on claims that were received June 3. It also stated that it’s “making every effort to reach their goal to be current in processing enrollment requests within 10 days of receipt of the request.”

As time goes on, it seems fewer and fewer providers report having problems. Rose Schafhauser, executive director of the Midwest Association of Medical Equipment Services, recently e-mailed about 200 providers to ask them whether they were having problems. Two responded that they were.

Unfortunately, for those providers having problems, it’s not easy “to get a resolution worked out,” Schafhauser said.

“Some providers are calling the helpline and they’re on hold for an hour-plus,” she said.