CMS revises policy but leaves patients 'in limbo'

Thursday, April 28, 2011

WASHINGTON - HME providers will once again be able to get partial reimbursement from CMS for certain power wheelchairs.

In an April 28 bulletin, the DME MACs announced that they plan to reverse a Feb. 4 policy change that prevented providers from using advanced beneficiary notices (ABNs) for Group 2 scooters and Group 4 power wheelchairs.

That's the good news. The bad news: The reversal won't take effect until June 1.

"It's not good for those folks to be in limbo for another three months," said Greg Packer, vice president of The VGM Group's U.S. Rehab. "We'll continue to work to advocate for the patients on that end of it."

The Feb. 4 policy change eliminated the least costly alternative language from the power mobility local coverage determination, causing the "unintended consequence," the DME MACs stated, of making Group 2 scooters and Group 4 power wheelchairs ineligible for ABNs.

Without the ability to use ABNs, providers stopped providing the equipment and consumers went without.

"Medicare beneficiaries don't have the kind of money to pay in full, so providers were holding the chairs, waiting for an update from the DME MACs as to how this issue might be resolved," said Julie Piriano, director of rehab industry affairs for Pride Mobility Products. "There's still a lack of clarity with regard to how a provider should submit a claim and how the claim will be paid in the interim between Feb. 4 and June 1."

Packer credits a concerted effort from industry stakeholders as being instrumental in CMS's decision. 

"I think CMS is listening," Packer said. "This is a great win for the industry."