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Georgia Medicaid Meeting 0 Barnes Healthcare Services Next week the GAMES Medicaid and State Issues Committee will meet with the Georgia Medicaid Chief. Primarily we hope to begin discussions regarding the impending 2019 federal cuts to the DME program as signed into law December 2015 within the OMINBUS spending bill. We hope to be collaborative and proactive with DCH in an effort to mitigate the impact of these changes to DME providers and the State’s healthcare system as a whole. What other topics or issues would you like for us to address while we have the opportunity?Please respond here in the forum if possible so that all members can be engaged in the discussion. However, if you have any issues with logging-in, please email me directly at everyone for your input!Charlie Barnes IVChief Executive Officer, Barnes Healthcare ServicesPresident-elect, GAMES
by Barnes Healthcare Services
Friday, October 28, 2016
CPAP and Blue Cross GA 3 Petsch Respiratory Services Note from our team. They do give the run around a lot. And No, they will not tell you what modifier to bill with. We only use RR, and bill up to the 10th month at which time it is capped/converted to sale.The only other time different modifiers are used are when the contract of a specific patient has a Medicare replacement plan. Then the Medicare modifier combination is used1st month- RR KH2nd and 3rd month- RR KI4th – 10th month -RR KJHope this is helpful
by Barnes Healthcare Services
Wednesday, October 19, 2016
New Overtime Rules 1 HirePowerHR Hey Richard - You are referring to the new rules that say anyone making less than 47k must be paid overtime even if they (their position) are exempt, correct? I hope we hear from some GAMES members how they plan to address this! But I do have one question - What if someone is travelling to a conference? If you have a manager that makes just under the 47k threshold and you send them to an educational conference, do you have to pay overtime for travel and sleeping in a hotel? Yikes! and FYI richard, this was teresa tatums question/comment (she hacked my account).  but i am interested to hear the answer as well, thanks chad
by Petsch Respiratory Services
Thursday, August 18, 2016
BCBS GA - long wait times 3 At Home Medical, Inc We utilize approval on line and it only takes a few minutes. Johnny Carroll
by Alliance Home Medical
Sunday, August 14, 2016
Medicaid- Procedure limit denials 0 1st America Home Medical Equipment For custom rehab wheelchairs, we are submitting and receiving approvals for new wheelchairs and accessories.  When we submit the claim, we are receiving denials on some items for ex.  "Procedure limit of 1 every 2 years" or other similar denials for limits.  We have been told by Medicaid to contact customer service and they can give us history for a HCPC code for that patient.  We have tried this without success.   Until recently, we have been reliant upon GMCF approving the equipment as the green light for coverage, however, that is no longer the case.    I wanted to ask if anyone else if having these types of denials and also, if anyone has had success in obtaining same or similar equipment information from Medicaid prior to dispensing equipment to the patient and billing?   Thank you in advance.​
by 1st America Home Medical Equipment
Tuesday, June 14, 2016
GA State Laws for medical equipment and prescription requirements 0 Shirley Smalling Does anyone have access or link the GA state laws that dictate prescription refill requirements.  This would be indicative to "may not be required for billing purposes" but state law mandates and new prescription every 12 months, this would be similar to the FL laws for oxygen refills.  We have been notified by a consultant that all PAP supplies require a new prescription every 12 months, and I have not been able to find this in writing.  Any information or links would be very much appreciated.  Thank you
by Shirley Smalling
Thursday, December 10, 2015
Univita and Peachstate 3 Shirley Smalling We received a letter on Monday stating that our application was approved by the Credentialing Committee on August 14th and that we would be contacted by the Contracting Department with our effective date. Also, that a Provider Relations Specialist would contact us for orientation.Hope this helps you!
by 1st America Home Medical Equipment
Thursday, September 17, 2015
WAKE UP RURAL PROVIDERS 1 M.R.S. Homecare, Inc. Tyler,You share great insight. I hope our rural friends and members will take up yours, mine and GAMES cause to stay vigilant. We need to stick together now more than ever to make through the storms. Glad you have my back and I will do all I can to have yours
Wednesday, November 19, 2014
standard 29 1 Archbold HomeCare Services Gail - I have some experience with this and will call you directly to discuss. Thanks - Bill Cheek
by B. Cheek
Thursday, October 2, 2014
DCH Audits!!! 2 M.R.S. Homecare, Inc. Mr. Riddle: They are asking for "Medical records" for anything you billed to Medicaid during that time frame. For each bill you sent to Medicaid, you must send in the signed delivery ticket, what the repair tech did, the physician's order for the repair and the physician's face to face chart notes within 6 months of the order and date of service. For new equipment, send everything you have that was sent to get the PA plus the delivery ticket and face to face chart notes. If you cant get all this together in 30 days, send what you have and continue to work to get the rest of the missing items (usually physician face to face chart notes) because when they come back to you in 6 months you will have the opportunity to appeal but you will again only have 30 days to do it. Rod Colver, Wolf Medical. 706-233-8200.
by Rod Colver
Wednesday, July 23, 2014
BCBS of GA. 3 M.R.S. Homecare, Inc. I hope you are all well aware of how BCBS of GA is attempting to destroy our State Health Benefit, I have heard from several members on the subject as well as members of the BOD, state health journalists, and others in the healthcare field (Docs and Labs) and wanted to "list our grievances" so that we as individual companies that make up GAMES can decide how we wish to approach BCBS. Barring individual action with BCBS, GAMES is unable to instruct or encourage our membership on how to proceed with BCBS, due to antitrust laws, we can however, openly discuss individual strategies and ideas on how we can as an orginazation deal with "Big Blue". The majority of the issues I am hearing backlash on are as follows (I will address each in more detail):1: reduction in reimbursement2: increased compliance/paperwork load to get the reduced reimbursement3: unnecessary recoupments/zero transparency in the recoupment process.4: lack of interaction/education with providers and beneficiaries. To begin we must start at the beginning, BCBS made some shady deals to get the state health benefit plan (SHBP), this is well known and was even garnered a lawsuit from United Healthcare, which proved unsuccessful (oh how i miss the good old days of UHC!!!).  BCBS used its leverage of the SHBP to hold all providers int he state hostage, and slash reimbursement (by up to 50% in some cases) guaranteeing the savings that they promised the state to backdoor their way into the plan. Once the plan and the network of providers was secured, BCBS has systematically begun to dismantle the SHBP.   With their latest announcement of how they will handle CPAP resupply and monitor ongoing compliance, BCBS is now the most stringent insurance that my organization has to deal with, even more stringent that the highest authority in the land Medicare. With the number of patients that are covered under the SHBP that fit the demographic of CPAP customers, BCBS has officially made it completely unprofitable to service SHBP CPAP patients.   Sadly, this is not the end of the BCBS's atrocities against Ga providers. Most recently BCBS has announced that they will begin recouping money from providers. Why are they recouping this money? They wont tell us. How much can we expect to pay back? They wont tell us. When will these recoupments end? They wont tell us. What they will tell us is HOW and WHEN we can pay back this money, and that we can actively chase the difference down from the customer.  Based on my conversations with labs and Physicians, (NOT BCBS BECAUSE THEY WONT RETURN MY CALLS OR ANSWER E-MAILS) it seems that BCBS has paid some claims in error. Rather than upset their beneficiaries in this turbulent time (See the following articles) they are taking back from us and forcing us to go after their beneficiaries, essentially making us the bad guys in our customers eyes... (AJC ARTICLE)(GA HEALTH NEWS ARTICLE)OF course this is all speculation, I have no way of knowing that BCBS's goal is to pass the buck onto GA providers to avoid any further embarrassment /beneficiary  backlash, what I do know is that at this point, in the point of declining reimbursement, shady dealings with DCH, increased difficulties with paperwork/documentation, and lack of communication with providers; I am not longer able to assume BCBS has anyone's interests at heart but their own bottom line. So, what is the solution? Do we light a fire under our beneficiaries? Do we band together with the hospitals and labs to send a message to BCBS? Do we organize like the teachers (Teachers Rally Against Georgia Insurance Changes)? Some of our own membership suggest that we retain attorneys and sue BCBS or DCH or both?I am extremely interested in what each of you think, so much in fact that I am begging your for comments, ideas, anything... If you have contacts at BCBS that answer their phones or return calls, I need them. Email addresses, mailing addresses etc... If you know people in the media now is the time to get this story out, reach out to your physicians, write letters to your customers... anything you can do will help.The danger we all face is one that we've all been hearing for some time now. If BCBS breaks us, it will not be long before the other third party insurers follow suit. and in this increasingly hostile environment for our industry, WE CAN NOT AFFORD a loss like that. I welcome any and all comments from every one of you, please e-mail me at or, attached is a copy of the letter that I have been sending to my BCBS rep every single day with no response.Tyler Riddle
by M.R.S. Homecare, Inc.
Tuesday, June 3, 2014
Nationwide Competitive Bidding - DME Bundling - CMS seeks comments 2 T. Tatum "If you are a DME provider and not thinking about this proposal and making your opinions known, you will be subject to the results of a process you did not get involved in. That is how Competitive Bidding was inflicted on this industry. This CMS request for comments is your invitation to participate!"I think that Jason has got it 100% right in saying this. As GAMES members and DME providers we are obligated to voice our opinions when asked. Tuesday Morning GAMES will host a call to offer all members a chance to give leadership their feedback on the ANPRM. I encourage all members to participate.
by M.R.S. Homecare, Inc.
Friday, March 14, 2014
WOPD? 1 M.R.S. Homecare, Inc. None here so far, but expect to see those occur when the audits happen a few months after the policy change....
by Chi-Chester's Homecare, Inc.
Wednesday, March 12, 2014
Walmart and Canes? 2 M.R.S. Homecare, Inc. We are getting them, just curious how the "big boxes" are getting away without them.
by M.R.S. Homecare, Inc.
Wednesday, March 12, 2014
WOPD 1 M.R.S. Homecare, Inc. Tyler -AAHomecare is developing an ongoing bullet point of issues with Face-to-Face and WOPD. Some other state associations have added a few comments/ questions also. AAH has been writing letters to CMS asking for clarification and explaining problems with parts of the policy. We can add to this list too if GAMES members have comments / issues.FACE TO FACE BULLET POINT LIST OF ISSUES: ·         Same physician must conduct the face to face and sign the written order prior to delivery ·         Original delay was for both WOPD and face to face from 7/1/13.  Education from MACS that they had to be implemented together and then changed in December 2013. ·         Delay enforcement of face to face and not WOPD, DME MACs educating not delayed due to the fact that CR8304 only speaks  to DME MAC contractors, it does not speak to CERT, RAC or ZPIC. ·         Requirements for documentation on WOPD in statute versus DME MACs stating WOPD and DWO are the same.  WOPD was intended to be a written dispensing order with 5 elements, not the DWO. ·         DME MACs indicating a missing element is not curable by a provider.  If a provider realizes an element is missing (NPI), obtains a corrected WOPD, they should be able to bill from the point that the written order was ‘cured’.  DME MACs indicate another provider can obtain a WOPD that is valid and bill going forward, but not the original provider.   DMDs cite there is no language that the WOPD can be cured, there is also no language that it cannot be cured, why assume it can’t? ·         Requiring a date/time stamp on WOPD and face to face documentation to prove receipt of items prior to delivery.    One DME MAC now indicates a fax date stamp would be ok.  If the face to face occurred on a date prior to or on the delivery and the physician signed and dates the WOPD on or prior to the date of delivery, this should be sufficient.  ·         The dear physician letter put out by DME MAC DMDs indicate that when the state requires a new written order (which some do annually) then the Medicare face to face rule applies and the patient needs to obtain another face to face.  The face to face rule should apply only when Medicare requires a new written order, not the state. ·         The dear physician letter put out by DME MAC DMDs indicates the date of the written order has to be before the date of service (which is the date of delivery).  It can be on the same date and has always been on or before for the few items that required a WOPD previously. ·         The requirement for a new face to face when there is an acquisition.  Historically, in acquisitions a new CMN document (this was back when CMNs were the requirement) did not need to be obtained if the acquiring provider felt the CMN in the purchased providers file met Medicare’s requirements.  The requirement for a new written order with a change in provider has led to the interpretation that a new face to face is required in an acquisition.  This is systematically impossible.  If provider A buys provider B and there are 5,000 patients with rental items that are on the list for face to face requirement, then 5,000 patients need to go to the doctor because provider A sells their business to provider B?  A with the old CMN requirement, an acquisition should be exempt from the face to face requirement, as long as the patient met the criteria for face to face when they were originally setup by provider A.
by T. Tatum
Thursday, March 6, 2014
GA Medicaid Appendix X 1 T. Tatum The requirement that any written order contain the height and weight for all beneficiaries age 21 and under no matter what items the patient is getting for DMEPOS is a bit extreme.  Height and weight do not matter when it comes to provision of disposable supply items such as Ostomy, Urological, Wound care etc.
by Camille Cassell
Thursday, October 31, 2013
Blue Cross Blue Shield 9 T. Tatum On Tuesday of this week, Teresa Tatum from GAMES, Todd Tyson of Hi-Tech Healthcare, Tyler Riddle of MRS Homecare, and Kathleen Yeakey of Soft Touch Medical participated on an hour-long conference call with Kathryn Norman, Nidhi Jagani, and Lori White of Anthem / Blue Cross Blue Shield.  We shared concerns and questions from the point of view of a provider in the Metro Atlanta area, a provider in the rural southern part of our state, and a specialty provider. We shared comments and concerns expressed by additional GAMES members in emails, forums, and telephone calls. Initially we attempted to show how the Competitive Bid prices were derived from a flawed and unproven method. They denied that their fee schedule was based on Medicare Bidding rates, but instead explained their fee schedule was proprietary and developed internally by their staff.  We did point out the unique similarities between their new schedule and certain Bid rates, but then moved on to showing the rates to be unsustainable regardless of their origin. Here again, our panel of DME providers did a terrific job and the BCBS representatives listened without interruption. We offered to assist with a task force or panel of providers to work with BCBSGA on reviewing and possibly making some changes to the fee schedule. They declined our offer. We asked that they consider a delay to implementing the new schedule so that they could consider some of our concerns and so that providers could consider operational changes that may be required. They denied the request. We discussed notifying patients about the reduction in services and the possible switch to less expensive products. BCBS does not intend to notify patients of any changes as their provider network is not changing. We discussed the potential for providers to turn down referrals on Friday afternoons and for patients they don’t think they can service. BCBS monitors this and suppliers should be careful not to breach their contracts. We shared concerns about complex, custom rehab products being reimbursed as rentals instead of purchase. We explained that these products were not reusable. BCBS assured us that they had not changed their policy regarding rental or purchase. What has been a rental, remains a rental. What has been a purchase, remains a purchase. In the end Kathryn informed us they were literally being bombarded by DME providers trying to get into their network. She hoped we would all remain, but let us know that we could be replaced if needed. (We suggested providers beating her door down had not seen the fee schedule.) Did we gain anything? What did happen is that they heard from us; someone higher up in their corporate structure listened. They are more educated now than they were before the call.  At this time, when individual (DME) providers contact them about a specific product or specific geographic or other issue, BCBS will be more open to considering these individual situations. Ms. Norman indicated "we are reasonable people”. As always, GAMES members should review documents carefully, consider having legal or other trusted counsel review, and then make the business decision that is best for your company. You are encouraged, however, to contact BCBSGA (network manager named in your letter) to discuss any unique circumstances relating to your organization, products, or services.
by T. Tatum
Thursday, September 19, 2013
New Face to Face Requirements 0 M.R.S. Homecare, Inc. Have any of you begun to educate your referral sources on the new F2F requirements? I am having a tough time finding an appropriate time to begin this process... We have begun mentioning the upcoming changes, but haven't started explaining things in depth to our ref.'s yet.I am attaching a guide that may be of some help to those of you that are unfamiliar with the requirements. H1 H2 H3 H4 H5 H6
by M.R.S. Homecare, Inc.
Wednesday, July 31, 2013
Connelly 3 M.R.S. Homecare, Inc. We have had this happen on a few RAD devices. Connolly called them "internal audits " as the reason we didn't get the letter. When they sent the recoupment letter we were able to find out the reason for the denial and get them corrected and approved at the next level.
by Barnes Healthcare Services
Wednesday, July 31, 2013
GAMES Reimbursement & Compliance Issues 0 T. Tatum Please use this area to discuss Reimbursement & Compliance topics.
by T. Tatum
Monday, July 29, 2013

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