Behind the numbers

Sunday, October 30, 2011

If you're like me, and you follow the Medicare Market Marker on our Databank page each month (partly because I have to put it together, but mostly because I find it interesting), you probably raised an eyebrow while reviewing the last few issues.

For K0823, your standard power wheelchair, the number of allowed beneficiaries has spiked. In Region C (why haven't we changed that to Jurisdiction C, by the way), that number increased from 5,411 (February) to 9,498 (March) to 12,525 (April). This month: 16,748 (May). See for yourself on page 46.

Wow, right?

But before you get the wrong idea. Let me rephrase that: Before CMS gets the wrong idea, let's think about this. Is there something that happened in January that would cause the number of allowed beneficiaries for K0823 to skyrocket?

Well, starting Jan. 1, the first-month purchase option was eliminated for all standard power wheelchairs. That means they're 13-month capped rental items. That means, as I understand it, providers must bill Medicare for each month a beneficiary is using a standard power wheelchair up to 13 months. And that means that same beneficiary is counted each month, instead of, when there was a first-month purchase option, only once at the time of purchase.

Hopefully, you noticed the disclaimer that we've added to the K0823 graph. Let me rephrase that: Hopefully, CMS noticed the disclaimer. It says:

On Jan. 1, 2011, standard power wheelchairs, including K0823, became 13-month capped rental items, meaning what was billed once is now billed as many as 13 times.

I'm going to keep an eye on this, and I'm sure CMS will, too, but as far as I can tell, there's no need to investigate further. Case closed.

Top providers

In our December issue, we'll publish our 2011 State of the Industry report. Part of that report: the top 100 suppliers of DMEPOS by amount allowed for 2010. You'll have to wait until December for the entire list, but here's a sneak preview of the top 10:



Liberty Medical Supply:


Apria Healthcare:


Accredo Health Group:




Lincare Pharmacy Services:




DEGC Enterprises (U.S.):


Braden Partners:


Hanger Prosthetics

& Orthotics: