CMS overwhelms wheelchair industry with bad news

Sunday, September 18, 2005

BALTIMORE - Medicare officials surprised the rehab industry Wednesday with a "distressing" draft local coverage determination for power mobility devices and 63 new codes and testing requirements.

While the much-anticipated draft LCD contains "a few nuggets of good information," it also raises serious questions, particularly about in-home use, said Cara Bachenheimer, vice president of government relations for Invacare.

As for the new codes and testing requirements, which came in the form of a 36-page document posted on Palmetto GBA's Web site, they're another blow to the morale of an already beleaguered industry. CMS had originally created 49 new codes to take effect Jan. 1. By creating a new set of new codes, CMS has added confusion to an industry already struggling to come to terms with multiple changes.

"The combination of theses two's overwhelming, and not in a good way," Bachenheimer said.

The industry had high hopes for the draft LCD, largely because it felt it would help clear up uncertainties in CMS's new interim final rule. The draft does address concerns that physicians will not provide suppliers with the appropriate supporting documentation by outlining a series of questions that physicians should answer in their notes.

The draft also clarifies in-home evaluations by stating that HME suppliers can determine whether patients can maneuver a power mobility device in their home upon delivery.

Still, the draft, which makes a "bright line distinction" between consumer mobility and high-end rehab, has a "lowest-common denominator objective" Bachenheimer said.

"The most distressing thing about the medical policy is that there's clearly an intent for beneficiaries to receive products that are only appropriate to use in the home," she said.

Neither the draft LCD nor the final interim rule it's supposed to clarify may even matter with the introduction of 63 new codes and testing requirements, Bachenheimer said.

"That was the one piece of the puzzle that was set," she said. "Now we're back to square one."

Invacare has already gone through the expensive and time-consuming process of testing some 30 products based on the 49 codes and testing requirements that were issued in February. The company has even received code verifications for most of its products.

"This document says those are null and void, but they're saying, 'We're going to look at your applications,'" she said. "It's unbelievable."

The draft LCD and new codes and testing requirements are both expected to go into effect on Jan. 1.