Cross-walked codes force Pa. HMEs to run for help

Tuesday, April 30, 2002

HARRISBURG, Pa. — Pennsylvania HMEs have enlisted the aid of state legislators to help locate the law that allows Medicaid to cut reimbursement to 80% of the Medicare allowable when it changes a product's code.

Medicaid began cutting reimbursement for "cross walked" codes in December 2000 when it cut reimbursement from 12% to 25% on 17 products, said Claire Turner, executive director of the Pennsylvania Association of Medical Suppliers.

"We said what's going on: It's the same item just a different code to identify it," Turner said. "We are very concerned and have been talking to legislators and they seem interested."

Some HMEs lost roughly $25,000 last quarter providing the 17 products with reduced reimbursement, but because some of the reductions amounted to pennies, not all providers picked up on the cuts right away, Turner said.

With new ostomy codes on the horizon and additional code changes slated to occur with HIPAA, Pennsylvania providers fear they could see reimbursement cuts on all their local codes. Those concerns add urgency to discovering which part of the state plan gives Medicaid the authority to cut reimbursement when it changes a products code or adds a code.

"We would then at least have the opportunity to argue with the department if we could see their methodology," Turner said. "Our thought is that if we could see what they are doing, maybe we don't have grounds to argue with them. But now we don't know where to start to argue." HME