ABN renews viability of walker
RICHMOND, Ill. - After years of wrestling with Medicare, Mary Harroun finally got what she wanted - a Medicare HCPCS code (E0144) unique to her Merry Walker Ambulation device. It was a short-lived victory however. Though she got the code, Medicare downcoded reimbursement for the combination walker, seat to a standard walker, which essentially shut her product out of the Medicare / home healthcare market.
But today, thanks to the Advanced Beneficiary Notice and the ability for Medicare beneficiaries to pay the difference between the allowable and the upgrade price, Harroun says the viability of her product in the Medicare market has got new legs.
"I've been selling 3,000-4,000 Merry Walkers every year," she said. "With the ABN, we'll probably double that."
The ABN is expected to provide impetus to innovation in medical product design since upscale products can now be sold into the Medicare market. Upscale products don't necessarily require a unique HCPCS, like Harroun's Merry Walker, and her struggle to obtain that code would suggest that not much innovation is likely to involve new HCPCS.
"It took me seven years," said Harroun. "I was writing an application a year."
And every year, her application was denied. Two years ago, she threw a party for her Congressman and playfully locked him in the Merry Walker, threatening not to let him out until he promised to help her get a HCPCS.
Her last application for a Medicare was 80 pages along. Medicare rules mandate that applications not exceed 40 pages, but Harroun wrote on either side, in eleven-point font, with the narrowest possible margins. "I blew everything possible into that application," she said.
This time it worked, and Medicare identified her seat-walker as a Propriocebtor Reflex Deficiency Corrective Device, the only one of its kind. HME