Friday, May 31, 2002

WASHINGTON - CMS has asked the DMERC medical directors to take a second look at the recently released ostomy codes and fees after receiving complaints from providers that the new codes and fees make billing too difficult, according to the United Ostomy Association (UOA).

The Irvine, Calif.-based UOA, which has worked with CMS since last year to shape the new codes and fees, fears the medical directors will come back to CMS with different codes and fees, and the association will be back to "square one."

"With a different reimbursement system, I know we'll lose the financial gains we made with the new set of codes," said Linda Aukett, chairwoman of government affairs for UOA. "I know we'll lose."

Twenty-two ostomy codes went into effect April 1, and several days later, new fees - some of which represent increases of $1 or more - were released.

Aukett said the difficulty in billing is this: The changes made to the codes involved breaking down existing codes (that's what made many of the fee increases possible), so providers have had to adjust their billing systems to handle claims with multiple lines. Things get especially tricky with the new add-on codes for pouches, she said.

Providers who file paper claims rather than electronic claims are the ones complaining to CMS, industry sources say. Those providers feel there's more room for problems with paper claims now running onto second and third pages. They also say it's a matter of money. The providers complaining don't want to adjust their billing systems or spend money to file more of their claims electronically.

Patti Langenbach, president of the Jacksonville, Fla.-based Medical Care Products, doesn't buy the excuses. She said she was hesitant to file claims electronically at first, too, but the conversion has allowed her to cut her turnaround time in half.

"My money comes back to me so much faster," she said. "A paper claim will take 30-40 days to get processed where I'm getting claims processed in 14 days."

Aukett said she knows this much is true: The providers complaining aren't giving the new codes and fees a chance.

"There's going to be a learning curve, for providers, for the DMERCs," she said. "I've talked to providers who thought the new codes were cumbersome in the beginning, but they sat down and made some changes, and it hasn't been a big problem."

Langenbach was one of those providers.

Providers who have already adjusted their billing systems say they'll be upset if CMS changes the codes and fees again, though. Langenbach said she's spent $5,000 to adjust her billing system to the new codes and fees.

Aukett said the UOA would meet with CMS after the medical directors have reviewed the new codes and fees, probably in about a month. She fears the medical directors will come back to CMS with "discrete codes for a given set of features." That would be a nightmare, she said, especially when new features are released. (With the new codes, each feature is billed individually.)

"Here we have this logical flexible system that can accommodate any feature," Aukett said. "What they want to see is extremely inflexible. There would be hundreds of possible combinations." HME