If PWC denials increase, so could repossessions

Sunday, February 29, 2004

YARMOUTH, Maine - As a result of Medicare’s strict new coverage criteria for power wheelchairs, some providers and industry watchers have begun uttering the “R” word, as in repossess.

“It is an election year, and I’ve had [Power Mobility Coalition] members tell me that if they have to go into beneficiary homes to take away their chairs they are going to call the press,” said Eric Sokol, director of the PMC.

In December, CMS issued a “clarification” that stated Medicare, in most instances, will pay for a power wheelchair only when the beneficiary is bed or chair confined.

Providers and industry leaders claim this coverage criteria is overly restrictive and excludes beneficiaries who can walk a few steps but still need a wheelchair to move safely around their homes. Because CMS plans to apply the December clarification retroactively, the industry is bracing for a raft of denials and requests for additional documentation.

“The industry is not being dramatically affected yet as a rule,” said Dan Meuser, president of Pride Mobility Products. “There are some companies that seem to have been singled out.”

One of those singled out appears to be Victoria Tarpey, owner of Med-Care Supply in Patterson, N.Y. Since September, CMS has cited a lack of medical necessity in denying payment on 20 chairs she provided to beneficiaries.

The New York Times chronicled her plight in a Jan. 30 story on CMS’s response to rising power chair utilization, fraud and abuse. “I’ve put all my savings into keeping the business afloat,” Tarpey told HME News last month. “We’re going into our fifth month of not receiving payments. I’m done. I have to find something else.”

Tarpey, who has appealed her denials, said she has thought of repossessing the wheelchair chairs but doesn’t think she could do it “in good conscience.”

One company not thinking about repossessing any wheelchairs in The Scooter Store, the nation’s largest provider of power wheelchairs. As part of its marketing efforts, the Scooter Store promises to provide a power chair at no charge to the beneficiaries, provided the Scooter Store prequalifies them and Medicare subsequently denies payment.

“We will not take back our customers’ wheelchairs,” said Margaret McCuckin, executive vice president of marketing. “That mobility and the Scooter Store has made a huge difference in beneficiaries’ lives, and we will not go back and repossess those.”
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