Kentucky: Providers can bill for diabetes

Sunday, January 23, 2011

LOUISVILLE, Ky. – Providers here learned in December that they will be able to bill Medicaid for diabetes supplies again, but some major unknowns loomed.

In July, the state had announced—via a website posting—that it planned to move all diabetes supplies and testing equipment from the DME benefit to the pharmacy benefit, effective Aug. 1. The move would have allowed the state to take advantage of manufacturer’s rebates worth approximately $2 million a year.

Providers succeeded in getting the implementation date pushed to Oct. to allow time for public comments on the matter.

“It’s a positive that we’ll be able to supply diabetic supplies,” said Teresa Camfield, executive director of the Kentucky Medical Equipment Suppliers Association (KMESA). “However, we will be paid at the average wholesale price (AWP), less (about) 14% to 15%. The cost of the glucometer may be more than the AWP.”

Other changes: Only certain brands of supplies are covered, but providers don’t yet know what they are; and providers will have to bill for the supplies using national drug codes (NDC). The changes in billing procedures meant the state had to do some computer programming to allow HME providers to bill using the NDC codes.