Medicaid revises policy

Saturday, February 28, 2009

ALBANY, N.Y. --The state’s Medicaid program has revised the prior approval process for patients eligible for both Medicare and Medicaid benefits. Providers hope the new policy will make it easier to provide Medicare non-covered items, such as power mobility devices used outside of the home.

The state has given the go ahead for providers to seek approval or denial using the advance determination of Medicare coverage (ADMC) process prior to delivering equipment. If the item is not eligible for ADMC, providers can submit a prior approval request directly to Medicaid.

Providers have been running into problems when they know Medicare is going to deny a claim, but Medicaid won’t act on the prior approval process until after Medicare has made a decision, said provider Jim Travis.

“By then it’s too late because we’re required to deliver the equipment in order to bill Medicare,” said Travis, president of West Seneca, N.Y.-based Buffalo Wheelchair.

At the very least, the new policy, implemented in January, should streamline the process, sources said.