Adjusted pricing comes backs to haunt accessories

Tuesday, January 26, 2016

WASHINGTON – CMS will use an adjusted fee schedule based on competitive bidding rates to pay for accessories for complex rehab wheelchairs despite a law passed in 2015 delaying the change for one year. “Although this change is effective Jan. 1, 2016, changes to the Medicare claims processing system cannot be implemented any sooner than July 1, 2016,” the agency states in recently posted instructions. On or after July 1, providers can adjust previously paid claims with dates of service on or after Jan. 1 to receive the full fee schedule amount, CMS states. Stakeholders responded to the instructions with disbelief. “We are reaching out to CMS and to our congressional champions to point out the unreasonableness of paying providers at reduced payment amounts for the next six months—this is what the year-end legislation was to prevent,” stated Don Clayback, executive director of NCART, in a bulletin to members. “It is also unreasonable to then require providers to have to ‘resubmit’ six months of claims after July 1 to get paid the proper amount.”