Providers in bid areas see glitch in payments

YARMOUTH, Maine - Some providers in Round 2 competitive bidding areas (CBAs) say they're running into trouble billing for complex rehab accessories. 

“Sometimes we get paid, sometimes we don't—it's very haphazard,” said Joe McKnight, vice president of business development for Anaheim, Calif.-based Aero Mobility.

Because complex rehab is excluded from competitive bidding, providers in Round 2 CBAs must use a KY or KE modifier on claims for accessories like batteries, chair backs and cushions to notify CMS that they're not bid items.

Unfortunately, the modifiers don't appear to be working.

“These claims are incorrectly denying for competitive bidding or underpaying at the competitive bid rate,” said Mary Shutes, director of reimbursement at Rochester, N.Y.-based Monroe Wheelchair. “Accessories on complex rehab chairs should be paid at the fee schedule amount and not the single payment amount.”

Since it is a billing processing error, providers may resubmit the claim until it is processed correctly, rather than filing an appeal. This still adds an administrative burden, says McKnight, especially as these denials increase.

“It's burdensome to provide custom rehab as it is,” he said. “This is another reason we need a separate benefit.”

At this point, all providers can do is sort out each claim on a case-by-case basis, they say.

“(Medicare Administrative Contractors) are saying, 'Bill for it this way and if it doesn't work call us,'” said Martin Szmal, founder of The Mobility Consultants. “Or they'll say, 'Resubmit, and we can try to adjust this in-house.'”

NCART Executive Director Don Clayback says CMS is aware of the issue.

“Suppliers are following the right processes,” he said. “CMS recognizes this is not the way those claims should have been processed, and they're planning to make the necessary correction.” HME