New York

ALBANY, N.Y. - The state Medicaid program hopes to do a better job of  weeding out inappropriate payments for certain HME this year, a move that it believes will save $1.9 million in 2010-2011.

The state believes the move will save even more money, $2.3 million, in 2011-2012.

"At first blush, it sounds like they're going to be putting more edits in the system," said Carol Napierski, executive director of the New York Medical Equipment Providers association (NYMEP). "We just hope they do it on the front end, when a claim is submitted, not the back end, when a claim has already been paid. Then there's potential that a provider will lose reimbursement."

In its executive budget for 2010-2011, the state details its plans to "apply additional utilization review controls" for HME like incontinence supplies; wheeled mobility products and accessories; shoes; diabetic needle supplies; hearing aids; and oxygen delivery systems.

The state's plan to increase its scrutiny of payments for HME, particularly incontinence supplies, wasn't a surprise, Napierski said.

"We've talked to state Medicaid officials at least three times about the need for stronger edits for incontinence supplies at the eligibility level," she said. "They concurred with us."

Still, provider Mary Lisa admits the state's plan to increase scrutiny makes her nervous.

"We're very careful, but a lot of the rules are up for interpretation," said Lisa, a senior director at Upstate Rehabilitation Products in Albany, N.Y. "Ultra-lightweight wheelchairs, for example, don't go through the prior approval process. So what we see as medically necessary--an auditor may not agree with us. We never know."