Elite Medical

Gladys Russell, Elite Home Medical Supplies, Brandon, Fla.

"How many days in a month?" That's a question Gladys Russell posed for so many months that she managed to move a small mountain: She got a Medicaid procedure changed in Florida.

In early 1997, someone in the programming department at Medicaid decided a month was 31 days, says Russell, office manager of Elite Home Medical Supplies in Brandon, Fla. It didn't take long for Medicaid to start denying reimbursement for supplies delivered on a monthly basis.

"If we had fewer than 31 days between deliveries, they would deny it", Russell says. "If we delivered two ostomy bags on the 20th of February, and two on the 20th of March, we would constantly get denials. We were losing a month every time there were fewer than 31 days in a month." (And, as any grade-schooler can tell you, five months have fewer than 31 days.)

It was one of those "little big things" that needed to be fixed, Russell says. The bureaucratic snafu affected payments for 150 patients in her company alone. But figuring out whom to contact in the grand maze of Medicaid proved to be a puzzle that took Russell nine months to solve.

"I just kept calling, tracking down people, writing letters," says Russell, resident sleuth of Elite's seven-employee enterprise. "It was February of 1998 when I finally got through to someone who got me to an HME specialist, and I left the question for her."

Just two hours later, the problem was solved. The definition of "monthly" was changed to 28 days. Patients who required regular deliveries of ostomy, incontinence or diabetic supplies could receive them and companies across Florida would once again be regularly reimbursed.

"Once I got the right person's name, she was a valuable ally," Russell says. Making the most of her new contact, Russell also spent an afternoon talking with her about the need to change ostomy rules to allow patients who require more than one ostomy bag to get reimbursed for them--and received a thank-you note from Medicaid for her effort

"None of these are policy changes," Russell says. "I changed practices. I got them to fix things so that the rules in place would work properly. I was just trying to get the machine to do what the law says it should do."

How can something so seemingly simple as the meaning of a month get so confused? Russell thinks it may have happened because the people making the rules at Medicaid often haven't operated within the home care system. "They can’t see the effect it is going to have," she says. If you

don't think it through, changing one thing sends out ripples in many different directions.

Russell has spent more than her fair share of time ruminating about the after effects. She even wrote a paper on the Medicaid quagmire for a college class she took on policies and procedures in social work. The title of her paper? How Many Days in a Month," of course. And she earned an A.

HC