Manual chair changes 'heat up' this spring

Wednesday, February 28, 2007

WASHINGTON - Still raw from CMS's overhaul of the power mobility benefit, the rehab industry has begun to prepare for another potential blow, this time to manual wheelchairs.
Discussions with CMS should "heat up" this spring, said Seth Johnson, chairman of AAHomecare's rehab council and vice president of government affairs for Pride Mobility.
"CMS has indicated that they plan to go through manual wheelchair coding, coverage and pricing in detail and break it out in the same way they did power wheelchairs to capture the various levels of technology currently in the market," he said.
Industry sources don't expect as big of a shake-up for manual wheelchairs. The agency will likely expand the number of codes-- especially for higher-end manual wheelchairs--but not to the degree it did for power wheelchairs (from four to 64 codes). It will also likely develop more defined coverage criteria.
As for pricing: "We should see some reductions, but we should also see some increases," Johnson said.
The possibility of additional codes is welcome news to some providers. They say the current K0005 code comprises manual wheelchairs with such a wide variety of features and technologies, making it difficult to get reimbursed properly.
"What we're seeing right now is that we're having to put people who should be in K0005s into K0004s, because we know we'll get paid," said Rob Summit, president of the Summit Group in Chattanooga, Tenn. "You automatically get paid for a K0004, but you're looking at three to six months in appeals for a K0005."
Tim Pederson, vice chairman of AAHomecare's rehab council and CEO of WestMed Rehab in Rapid City, S.D., called the K0005 the K0011 of manual wheelchairs. Pederson said he would also welcome more defined coverage criteria.
"Right now, there's no coverage criteria, in terms of who gets a certain wheelchair and who doesn't," he said.
In what sounds like a preliminary warning to CMS, however, providers said any cuts to reimbursement for manual wheelchairs may put smaller providers over the edge.
"We feel there's already been such a drastic cutback (with power wheelchairs)," said Don Whitney, operations manager for Inland Medical and Rehab in Spokane, Wash. "The independent providers can't take much more."
Industry sources have crossed their fingers that their discussions with CMS on manual wheelchairs will go more smoothly than they did for power wheelchairs.
"It can't go any worse," said Don Clayback, who heads up The MED Group's rehab network. "Certainly, from some of the problems they encountered with power wheelchairs, CMS has learned that they need to include the industry on the front end and collaboratively to avoid a crisis-type situation."