Tennessee: 'It's been very tough when you add up all these cuts'

NASHVILLE, Tenn. - After going the better part of 2009 without the state's Medicaid program chipping in its usual 20% for dual-eligible patients, HME providers are getting somewhat of a reprieve.

Medicaid has begun chipping in again, but only about 5%, providers say.

“It's always been Medicare pays 80% and Medicaid pays 20%,” said Scott Perkins, general manager of Bradley Medical Equipment in Cleveland, Tenn. “But then they started sending us remittances with zero balances. We called and called, and they told us Medicare's allowables exceeded Medicaid's, so they weren't going to reimburse us anything. They say they've opened things back up, but we haven't seen anything yet.”

The state withheld the 20% due to a budget crunch. When things didn't end up being as dire as the state thought, it started chipping in again, providers say.

But 5% isn't enough, not when they're still grappling with a 9.5% reimbursement cut from Medicare in 2009 and cuts from other payers, including BlueCross BlueShield of Tennessee, providers say.

“It's been very tough when you add up all these cuts,” said Monty Lankford, president and CEO of TLC Medical Oxygen in Franklin, Tenn.

Perkins agreed: “It was a 3% loss across-the-board in 2009.”

Providers continue to make their plight known to Medicaid officials and their patients.

“We tried sending out invoices to our patients—not to collect the 20% from them but to show them Medicaid wasn't being responsible for what they said they would be responsible for,” Perkins said. “A few patients called Medicaid and they told them, 'We paid.'”

Perkins added: “Sometimes you just feel you're banging your head against the wall.”