Custom seats, backs return to individual pricing

Friday, April 28, 2017

WASHINGTON – The DME MACs for Jurisdictions B and C have agreed to process all holding claims for custom seats and backs based on individual pricing, Rita Stanley, vice president of government relations for Sunrise Medical, announced at the National CRT Conference on April 26.

Stanley says she was told there are 30 or so such claims for E2609 and E2617.

“As of today, they were going to start processing those claims based on individual consideration again,” she said. “If the pricing information they need was submitted, the claims will be processed right away. If the pricing is not attached, they will reach out to suppliers.”

The DME MACs for Jurisdictions B and C had transitioned to set pricing for custom seats and backs earlier in April, putting E2609 at $450 and E2617 at $550, according to previous reports by The VGM Group. Traditionally, seats and backs are priced individually and average about 70% of MSRP/supplier price, VGM says.

The DME MACs for Jurisdictions B and C will reopen and pay the difference for claims that have already been processed based on set pricing, Stanley says.

In the long-term, the DME MACs for Jurisdictions B and C say they may permanently return to individual pricing for custom seats and backs, but that they were still “in the process of evaluating” the change, Stanley says.

Swift industry reaction and action is responsible for the turnaround, Stanley says.

“When we’re united as an industry and when they hear us crying out in a strong way, they’re much more likely to react quickly,” she said.

The DME MACs in Jurisdictions A and D never implemented the change.