CMS pushes providers to ‘breaking point’

Friday, February 5, 2016

YARMOUTH, Maine – Some providers say they’re cutting back on offering certain products and services after CMS said it would pay them at reduced payment amounts for accessories used on Group 3 power wheelchairs.

"We’re taking it on a case-by-case basis, looking at each piece of equipment and determining if that’s something we can provide through Medicare," said Sean Andrews, finance manager at Bedard Pharmacy & Medical Supplies in Auburn, Maine. “We get requests for specific equipment from therapists and we probably won’t be able to offer what they’re asking for for their patients because of these reimbursement cuts.”

Despite a law passed last year delaying the change in reimbursement for one year, CMS said in January it wouldn’t be able to adjust its claims processing system until July 1, 2016. It instructed providers to resubmit claims at that time to get full reimbursement.

It’s an “unconscionable” move by CMS, says Georgie Blackburn, vice president of government relations and legislative affairs at Tarentum, Penn.-based Blackburn's Physicians Pharmacy.

"CMS could work more effectively than what they're demonstrating,” she said. “If this were the beginning of competitive bidding, the rates would be in effect on day one."

Providers could never get away with this type of behavior, either, says Dan Afrasiabi, president of Anchorage, Alaska-based Geneva Woods.

"We could never say, ‘Sorry, we’re not in a position to change our systems, so we’re going to bill you a higher amount,’” he said. “It just points to the asymmetrical relationship between providers and CMS.”

Many providers feel that CMS is testing them to see how far the agency can lower reimbursement rates before too many of them go out of business and access to care becomes an issue.

“I think we’re reaching our limit,” said Bruce Bayes, owner of Largo, Fla.-based Custom Mobility. “We've given, the manufacturers have given, everyone's given. It's at a breaking point."