CMS adds three prongs to address PWC policy ...

Monday, May 31, 2004

WASHINGTON - Eight months after CMS’s Wheeler Dealer 10-point plan cracked the whip on the power wheelchair industry, the administration issued a series of further steps focused on coverage, payment and quality of suppliers of power wheelchairs.

The three-prong approach, released in April amidst a storm of reports and testimony on K0011 abuse, was called by CMS the “next stage” in strengthening power chair policy following the agency’s recent success in reducing fraud and abuse.

Since September 2003, CMS, the Justice Department and the OIG have recovered $84 million in fraudulent claims, and 155 potential fraud cases have been uncovered, according to the press release.

“With this new initiative, and with input and feedback from suppliers and beneficiaries, we are going to do even more to make sure that Medicare funds are spent on patients who need them, and that beneficiaries with disabilities are getting the high-quality, modern service they deserve,” said CMS chief Mark McClellan in a press release.

The first prong of CMS’s plan is to develop better instruction on the coverage of power wheelchairs, including the development of guidelines to help determine what patients are “truly bed or chair confined.”

The second priority is to re-evaluate billing of power wheelchairs and scooters. Technology advancements and a growing range of products have rendered the current code set, created in 1993, obsolete. CMS is working with a national coding panel to develop a new set of codes that will better reflect the variety of power mobility options available. Further, CMS said it expects to include power mobility in a competitive bidding program, which is set to begin in 2007.

The third prong of the plan promotes the creation of quality controls on suppliers. CMS is going to revise the supplier standards for enrolling in Medicare and develop an accreditation program, a provision also included in last year’s Medicare Modernization Act.