'It's a train wreck'

Wednesday, March 24, 2010

ATLANTA - The Georgia Medicaid program in November plans to reprocess all claims paid since July 1 to make sure they reflect new reimbursement and policy changes for DME, including complex power wheelchairs.

The state has decided to change the Medicaid allowables for DME to 80% of Medicare's 2007 allowables. It also has decided to close and open numerous codes.

Here's the catch: The effective date of the changes was July 1, but codes weren't opened until Sept. 1 and the new reimbursement rates won't be implemented until Nov. 1.

"It's a train wreck," said Weesie Walker, manager of the National Seating and Mobility branch in Atlanta.

If the state determines that a provider owes Medicaid money, it plans to withhold payment on future claims until his debt, so to speak, is paid off, stakeholders say. Then it will resume payments.

Stakeholders expect the changes to cause cash flow problems. They also predict a paperwork logjam.

"If I have a claim that's denied, I have to go back into the system, make a prior approval modification with the new rates and codes, then resubmit it for payment," Walker said. "That's a huge amount of work--for providers and Medicaid."

Stakeholders also expect providers to have a hard time maneuvering the new codes. The state will continue to allow providers to use K0108, a miscellaneous code for wheelchair components and accessories, but only for certain products and services. Also, it's not clear which codes need prior approval and which don't.

"The dissemination of information has been very poor," Walker said.

No good will come of the changes, stakeholders say.

"It's going to be a race to the bottom for the cheapest equipment," said Laura Cohen, co-coordinator of The Clinician Task Force.