K0011 change whacks Florida providers

Tuesday, January 31, 2006

TALLAHASSEE, Fla. - It has always taken a long time to get paid by Medicaid, but 2005 gave "long time" new meaning for some, say Florida rehab providers.
It now takes, on average, two weeks longer to get paid for K0011 wheelchairs, said Raul Lopez, president of the Florida Association of Medical Equipment Services and director of operations at Miami Lakes, Fla.-based Bayshore Dura Medical. That's on top of the 90- to 120-day norm.
But Tom McEnany, owner of Jacksonville, Fla.-based Wheelchairs Plus, reports it has taken him as long as eight months to get paid for a K0011 chair, thanks to changes Medicaid made to operations in early 2005.
"Fortunately, we didn't have too many of those," said McEnany, who watched his Medicaid business drop from 60% to 30% in 2005. "But they're trying to make it so difficult that people say, 'Forget it. I can't go through this.'"
The problems, providers say, have their roots in Medicaid's decision to require prior authorization for all K0011 chairs, and its decision to shift claims processing for the chairs to Tallahassee.
But, while another industry source agreed there was a delay in processing initially, Medicaid now approves K0011 chairs in less than 30 days. What slows the process down, the source said, is providers who don't submit complete paperwork.
Regardless, numerous providers reported they were seeking out business with the state's various waiver programs, because it was "a little easier to get paid that way." The programs use Medicaid money but reimburse providers using a separate fund.
Bill Webber, owner of Tampa, Fla.-based A-Ability Medical Equipment, said he's working more with a local Shriners outfit, because the organization "completes paperwork thoroughly."
While he acknowledged, "things are more bogged down than usual," not all is bad in the world of Florida Medicaid, said Butch Vanderpool, owner of Winter Haven, Fla.-based All Ways Accessible Rehab.
"We can bill them electronically now," he said. "It's kind of antiquated, because you have to have a dedicated modem to Medicaid. But if I can bill them and get paid in two to three weeks, I'm going to get a dedicated modem."