Accessories: Time to follow up, stakeholders say

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Friday, July 31, 2020

WASHINGTON – Complex rehab stakeholders are working with their champions in Congress to craft a letter asking CMS to permanently change its payment policy on accessories for complex rehab manual wheelchairs. 

That letter may take the form of a “Dear Colleague” letter requiring signatures, said Don Clayback during a recent webcast, so stay tuned. 

“We’re asking CMS to change the policy so it’s consistent with (accessories for complex rehab power wheelchairs),” said Clayback, executive director of NCART. “When it comes to parts and accessories, there really should be equal access.” 

Late in 2019, Congress passed a bill that included language suspending competitive bidding pricing for accessories for complex rehab manual wheelchairs for 18 months starting Jan. 1, 2020. 

Stakeholders and their champions in Congress – who include Reps. John Larson, D-Conn., and Lee Zeldin, R-N.Y., and Sens. Rob Portman, R-Ohio, and Bob Casey, D-Pa. – pushed for the delay to “give CMS enough time to evaluate the change,” Clayback said.  

“(Now we need) to make the request to CMS officially,” he said. 

While the suspension of bid pricing technically went into effect Jan. 1, CMS was only able to update its systems for July 1. 

“For any claims submitted for (accessories for complex rehab manual wheelchairs), you should be using the KU modifier, regardless of where the beneficiary resides,” said Dan Fedor, director of reimbursement and education for U.S. Rehab, a division of VGM, during the webcast. 

For previous claims submitted with dates of service of Jan. 1 to June 30, providers can submit for retroactive payment adjustments through a resubmission process using a Reopening Request Form, he said. 

Stakeholders have been trying to stop CMS from applying bid pricing for accessories for years. In 2015, industry champions were able to stave off bid pricing for accessories for complex rehab power wheelchairs for a year. In 2016, they were able to do it again for another six months. CMS then decided not to apply bid pricing for accessories for complex rehab power wheelchairs, starting July 1, 2017. 

Bid pricing for complex rehab manual wheelchairs, however, has been in place since Jan. 1, 2016.