Prepay reviews gain traction

Thursday, August 25, 2011

WASHINGTON - If power wheelchairs get put on prepay review, an overwhelming majority of mobility providers would stop providing the equipment, according to a new survey by The VGM Group's U.S. Rehab.

Why? Such reviews could leave providers holding the bag. They'd provide a wheelchair to a beneficiary and submit a claim to CMS; CMS would receive the claim, request documentation, and then decide whether or not to pay.

"99.5% would not continue to provide the equipment if it was all on prepay review," said Peggy Walker, a billing and reimbursement adviser for U.S. Rehab, which will share the survey results in talks with lawmakers.

A prepay review for power wheelchairs keeps cropping up in discussions on how to cut Medicare costs--first as part of the president's budget for 2012 and most recently as part of debt talks.

Walker says that, given the choice, providers would prefer prior authorizations: They would require a provider to submit documentation prior to providing a wheelchair to a beneficiary.

"A prior authorization (is never) a guarantee of payment," she said. "But it gives you something that says, at least you've got a chance."

Providers fear that the idea of a prepayment review for power wheelchairs is gaining traction.

"Things that get put in a president's budget sometimes seem to come to fruition," said John Letizia, chair of AAHomecare's Complex Rehab and Mobility Council and owner of Laurel Medical Supplies in Ebensburg, Pa. "Elimination of the first-month purchase option was in president Bush's budget--that's how that got introduced."

At the end of the day, it's patients who would be most affected, Letizia says.

"Prepay review--to me, for my business--is going to directly impact what consumers can get," he said. "(Lawmakers are) picking up couch cushions looking for nickels right now. They don't care about the consequences, especially to the patient."