HMEs wait months for approval

Thursday, January 31, 2008

MONTGOMERY, Ala. - A backlog of Medicaid prior authorizations has forced providers to go without payment and beneficiaries to go without certain home medical equipment for up to half a year.
Providers have always had trouble getting timely prior authorizations for hospital beds, wheelchairs and other HME, but when the state outsourced the process to Atlanta-based APS Healthcare in mid-2007, things went from bad to worse, they say.
"Everyone's having a hard time with it," said Krystal Wade, billing manager for Fuller Medical in Gadsden.
Providers expect to wait at least 30 days for prior authorizations, they say, but not six months. Fuller Medical, alone, has been waiting months to hear back about some 20 prior authorizations. The reason for the backlog: APS Healthcare's lack of manpower, according to Michael Hamilton, executive director of the Alabama Durable Medical Equipment Association (ADMEA).
"APS hasn't staffed up fast enough to keep from falling behind (on prior authorizations)," he said. "It hasn't come close to meeting its contractual agreement (with the state)."
The ADMEA planned to make prior authorizations the only topic of discussion at its meeting in January, Hamilton said.