Industry presses for details on bundling

Wednesday, November 26, 2014

WASHINGTON – Industry stakeholders are seeking answers to a laundry list of questions regarding CMS’s “incredibly vague” plan to bundle payments for standard power wheelchairs and CPAP.

“We’ve posed several questions already and will submit about a dozen more,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “CMS has indicated they are compiling the questions and will respond to the industry. CMS knows the bundling thing is incredibly vague.”

Among the unanswered questions: how will CMS calculate the bid ceiling, what codes are included in the bundles, how will CMS deal with documentation issues, and what is the timeframe for implementing bundled payments.

“My bet is on 2017,” said Brummett. “We’ve got the Round 2 recompete, the expansion into non-bid areas. To pile bundling on top of that—there’s no way they’ll be able to get it all done.”

Also unknown: the 12 CBAs included in the demonstration and whether the CBAs will be the same for both product categories.

Although the industry is used to CMS seeking to rein in costs by lowering payments, lumping multiple codes—there are a couple of hundred codes for accessories for standard power wheelchairs—into a single payment is a concern. Wheelchairs and CPAP were likely targeted because CMS considers them overutilized, not because they make the most sense to bundle.

“They think those are overused and overpaid and think doing this will drive down the costs,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Boiling down the bid system to bidding and billing for far fewer codes then they use today is scary.”