Q and A: Peggy Walker

Monday, June 21, 2010

In her office in Columbia, S.C., Peggy Walker, the billing and reimbursement adviser for U.S. Rehab, a division of The VGM Group, is surrounded by faxes-literally. Wheelchair providers often fax her claims for review before they submit them to Medicare and other insurers to make sure they're up to snuff. Walker keeps those faxes for a year, from June to June. Usually, they fill three boxes; this year: 17. "People are realizing that, yes, they've been able to push things through for so many years, but it's not going to happen anymore," she said. Here's what Walker had to say about where providers are botching billing and how things may get harder before they get easier.

HME News: It sounds like there's more pressure than ever for providers to bill correctly.

Peggy Walker: With all of the audits and reviews going on, yes. Sarah Hanna and I have formed a road show, and we go to the state association meetings and we tell people, "It's time to get back to basics. This is what you have to have: You have to have a good delivery ticket." That sort of thing.

HME: How are providers botching billing?

Walker: There are a lot of providers missing out on the KE modifier. There are accessories on some items that were competitively bid that can still be billed for those items and for items that weren't competitively bid. Like adjustable height armrests--they can be billed on a Group 2 chair, which is part of competitive bidding, and a manual chair, which isn't. Providers thought that, because they weren't in a competitive bidding area, they didn't have to use it or they just didn't know about it. That's 9.5% in reimbursement plus a 5.5% cost of living increase on accessories that could have been billed since Jan. 1, 2009–that's a lot of money.

HME: What's your advice to providers facing an onslaught of audits and reviews?

Walker: Basically, the best offense is a good defense. You want to get your paperwork ready upfront. Some of the DME MACs, like Cigna and Noridian, have good check off sheets that providers should be using.

HME: What's your crystal ball telling you about the future?

Walker: I think this year is going to be hard, but I think it's going to get better, because providers are becoming smarter. They're looking at more cash. They're using more ABNs. They're not putting all their eggs in one basket. No one should be 80% Medicare; that's ridiculous. They're learning to say no. If referral sources aren't going to help out with documentation, then those may not be the best referral sources to work with, because if you don't have documentation, you're not going to get paid, anyway.

HME: Speaking of referral sources–it's almost more important for them to be educated than providers.

Walker: That's why I'm doing more education to referral sources. In fact, when I go to Missouri next week, I'm going to be doing 150 docs and referral sources. Usually that's the average sized crowd that I get when I do community forums.