'It could be problematic'

Saturday, June 30, 2007

WASHINGTON - CMS's plan to competitively bid complex rehab products has a few wrinkles that could prove "problematic" for providers, industry sources say.
At press time in early June, CMS still hadn't released final codes and testing requirements for power mobility devices (The agency implemented temporary codes Nov. 15, 2006). That means providers who plan to participate in competitive bidding may have to base their bids on codes that could shift slightly.
If CMS tweaks the testing requirements, for example, a certain model of a power wheelchair could slide from one code to another, industry sources say.
"Because providers are bidding using today's codes and looking at where their models fit into those codes, it could be problematic if some of the classifications or testing requirements change," said Cara Bachenheimer, vice president of government relations for Invacare. "We just don't what the changes will be."
Providers should protect themselves by selecting back-up models for each code, say industry sources.
"They'll have a primary choice for each code, but they should also have a secondary choice," said Simon Margolis, executive director of NRRTS. "They'll want to ask themselves, 'Can I still make a living if I have to use that secondary choice?'"
Rehab providers have to base their bids on less than a year's worth of historical data, Syd Gubin, owner of Seating Center in Palm Springs, Calif., also pointed out.
"We've only been using the new codes for nine months," he said.
Another wrinkle: To participate in competitive bidding, rehab providers must have at least one ATS, ATP or CRTS on staff at each location. In San Bernardino, a competitive bidding area (CBA) that covers a vast geographic area, only six providers have ATSs on staff, Margolis said.
"There's going to be a lot of bidding where the winning bidder may be thrown out (due to that requirement)," he said.