Policy reduces coverage by 50%

Tuesday, June 30, 2009

WASHINGTON--The rehab industry has decided not to take CMS’s new billing policy for wheelchair repairs lying down.

AAHomecare’s Rehab and Assistive Technology Council (RATC) sent a strongly worded letter to the DME MAC medical directors in May, requesting that they drop the policy. The council’s argument: The policy violates longstanding Medicare rules.

“What they’ve done is quite unprecedented,” said Tim Pederson, co-chairman of the RATC and CEO of WestMed Rehab in Rapid City, S.D.

Under the policy, which went into effect April 1, providers must bill for repairs using standardized labor times. They must bill no more than 30 minutes, for example, to repair or replace a battery on any power wheelchair.

The RATC argues the policy violates Medicare rules because “a plain reading of the coverage provision in the (Benefit Policy and Claims Process Manuals and the Program Integrity Manual) shows that there are no limits on the units for service that Medicare covers for repairs, provided that all coverage criteria are met.”

Additionally, the RATC argues that the medical directors should have released the policy as a proposed policy with public comment.

The RATC has decided to fight the policy because it has resulted in “an almost 50% reduction in the coverage for labor from previous levels,” according to an informal study conducted by AAHomecare.

“There are a lot of steps that aren’t factored into what they put forth in this policy,” said Julie Piriano, director of rehab industry affairs for Pride Mobility Products. “It takes time to clean, disinfect and disassemble a chair; determine what parts are necessary to repair it; and then make the repair.”