Thursday, January 31, 2002

Mending confusing HCPCS

Q. Far too often the HCPCS codes do not adequately describe the product being provided. When that happens, either the dealer receives a reimbursement that is too low, or in other cases, too high. Why does this happen?

A. The standards for each HCPCS code do not describe specifically what will be reimbursed. A dealer may have an Rx for a walker or a cushion, and the range in quality and price for these items is rather large. A walker can be inexpensive or comparatively expensive, but the reimbursement is the same.

Or, how many cushions have been billed incorrectly and dealers reimbursed for an EO-176 when in reality the cushion is an EO-192? An EO-192 is considerably different from an EO-176 and more money, but after reviewing the current descriptions, the higher will be chosen.

Dr. Kenneth Nelson at the SADMERC is aware of the problem dealers face when trying to determine which HCPCS code to use. His staff has restructured the requirements for billing wheelchair seating. The new standards, when finaly approved, will allow HMEs to be properly reimbursed for the cushions they provide. I would like to see a complete revision of all HCPCS codes, and I feel that Dr. Nelson can eventually bring this about, and both the DMERC and the dealer will benefit.

Sheldon Prial is the director of government relations for The VGM Group. Reach him at 321-255-3885.