Committee audits Medicaid

SACRAMENTO, Calif. - Providers who believe Medi-Cal, the state's Medicaid program, has given them mixed signals over power wheelchair reimbursement now have the support of a legislative committee. A 12-member Joint Legislative Audit Committee held a hearing in August and voted unanimously to audit Medi-Cal for charging rehab providers with violating an obscure upper billing limit rule. The audit--which will consume 1,740 hours and cost $147,000, said Tom Lambert, president of Maximum Comfort in Redding, Calif.--began in October. "I think the committee said it best: 'It's a conundrum,'" he said. "We have two sets of rules." At question: Should providers bill Medi-Cal for power wheelchairs--namely the old K0011, now the new K0823--at cost-plus 100%, as defined by the upper billing limit rule; or should they use Medicare's rates? Medi-Cal argues that because K0011s can cost as little as $1,500, providers should bill less than Medicare's rate of about $5,000 in some cases. Providers argue they were told to use Medicare's rates, except for unlisted and uncoded equipment. Lambert worked to get the hearing with the help of Assemblyman Rick Keene. Keene represents Chico, Calif., where Maximum Comfort has a location. "I explained the problem to him like this: If the state is right, then myself and all of California's 900 providers have been overbilling Medi-Cal," Lambert said. "As a taxpayer, I don't like that, and you shouldn't either. I couldn't go down there and say, 'Poor me, they're beating up on Tom Lambert.'" If the results of the audit fall in providers' favor, Lambert said, "All the providers who were called on the carpet will be exonerated." If they fall in Medi-Cal's favor, and providers should bill the program at cost plus 100%, Lambert plans to work with legislators to "raise the limit."