MAC takes more physical stance on manual wheelchairs

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Friday, April 6, 2018

WASHINGTON – Industry stakeholders fear a Medicare Administrative Contractor is doing an about-face on the home assessment requirement for manual wheelchairs.

It’s been the industry’s understanding, in line with the current local coverage determination, that providers may conduct home assessments for manual wheelchairs directly or indirectly. In the case of the latter, providers may simply ask Medicare beneficiaries or caregivers questions about their homes to make sure the layout, for example, supports use of the manual wheelchairs being provided.

After a number of denials as part of CMS’s new Targeted Probe and Educate program, however, stakeholders have learned from CGS Administrators, the MAC for jurisdictions B and C, that nothing short of a “physical assessment” is adequate.

“They’re not budging,” said Sylvia Toscano, president of Professional Medical Administrators in Boca Raton, Fla., who has been corresponding with CGS. “They say they’re going to issue a new checklist or FAQ that states a physical assessment is required, which is not in the LCD.”

In an email CGS states that, “Since the MWC is being ordered for in-home use and a home assessment is part of the Medicare requirement, the supplier must do a physical assessment of the home to ensure safety and effective use of the chair within that environment, regardless of where it’s delivered.”

That last part—“regardless of where it’s delivered”—is the kicker, stakeholders say. When providers deliver to homes, they do home assessments directly, but when they deliver to hospitals for discharges they typically do them indirectly.

“No one goes to the home to do an assessment and then delivers to a hospital—if the patient is in the hospital, they’re not even home,” Toscano said. “Are providers supposed to deliver to the hospital then follow the patient to their home to do the assessment? Does the date stamp on the assessment have to be prior to delivery? It opens a whole can of worms.”

The apparent change also makes providing manual wheelchairs directly from showrooms impractical, stakeholders say.

“It, in effect, ends our ability to deliver manual chairs to a hospital or provide them from our stores,” said David Bruinsma, CEO and seating specialist at Colonial Medical Supplies in Altamonte Springs, Fla. “It’s concerning.”

Stakeholders plan to continue pressing CGS for feedback on why it appears to be changing its stance on indirect home assessments for manual wheelchairs.

“I understand why they’re doing it, but it doesn’t fit how HMEs operate,” Toscano said.

Comments

For quite some time now, Medicare has said that a supplier, for manual wheelchairs only, can do a verbal assessment upon or prior to dispensing, but before billing, the verbal assessment must be validated by an in-home assessment. As a company, we just made the decision to always deliver to the home. At the hospital, they can use the hospital's wheelchair to get to car, and we just don't do in-store deliveries for manual wheelchairs unless the customer is paying cash. 

It is extremely frustrating to deal with Medicare.  As DMEs, we are constantly expected to do more and get paid less.  Costs go up and reimbursement goes down.