Cindy wrote: "..if the doctor orders a breastpump and gives a dx for which
coverage is acceptable under Medicaid then the DME provider must first
apply to the HMO for coverage, then if the HMO denies the claim, the DME
provider can forward it to Medicaid and get paid.   To get Medicaid
reimbursement you have to apply for a Provider number and then follow all the
billing procedures.  I don't think you  have to be a big DME provider to do
it..."
I agree - the size of the company does not matter. The problem I have found
is that the HMOs may not be accepting new providers. For some, you have to
be JAHCO certified. If, for whatever reason, you do not get a provider
number, you cannot get a denial which would enable you to bill Medicaid. ie
if you are denied because you're not a provider, you can't bill Medicaid.
So I guess it tends to be the larger DME suppliers that handle this...
On this topic, I can't imagine how Medicaid breast pump rentals are
profitable even for the largest DME suppliers, considering the returns, if
they have to go through so much bureaucracy...
Anne Merewood