Medicaid Kentucky – DME Update

Each year Kentucky Medicaid is required to provide an Upper Payment Limit demonstration for CMS on DME codes covered by Kentucky Medicaid. This demonstration must reflect reimbursement rates for Kentucky Medicaid are set at or below the rates for the same codes listed by Medicare. Kentucky Medicaid was notified by CMS that we were out of compliance and must make adjustments to our fee schedule. To bring Kentucky Medicaid into compliance the Department for Medicaid Services immediately ordered a rate change adjustment to the 2020 DME fee schedule retroactive to 1/1/2020. This resulted in paid claims with any codes having rate decreases to automatically trigger a recoupment. The recoupment was in error.  The recouped amounts will be reprocessed and repaid.  Kentucky Medicaid apologizes for the late notice and any inconvenience that this has or may cause.  The new effective date of the rates is 11/15/20.

Source: https://chfs.ky.gov/agencies/dms/Pages/feesrates.aspx