Private payers, Medicaid dig in

Sunday, May 31, 2009

Rehab providers knew it was only a matter of time before other payers picked up on Medicare’s 9.5% reimbursement cut for standard and complex power wheelchairs.

In recent months they have reported that some private payers and Medicaid programs, including the New York Department of Health on April 1, had implemented the cut.

“We’re very discouraged,” said Bill Tobia, owner of Home Medical Equipment in Garden City, N.Y. “When they didn’t do it in January, we didn’t think they were going to do it at all.”

Medicare cut reimbursement for power wheelchairs on Jan. 1, as part of a deal the industry brokered with lawmakers that eliminated the products from national competitive bidding.

The Medicaid cut is especially painful for complex rehab providers, industry sources say.

“Since they tend to do a little more Medicaid than Medicare, it’s squeezing them even more,” said Sharon Hildebrandt, executive director of NCART.

Provider Gary Gilberti has tried to lobby private payers not to implement the cut - to no avail.

“They say their systems can’t accept different fee schedules than Medicare’s,” said Gilberti, president of Chesapeake Rehab Equipment in Camp Hill, Pa. “But you never know if that’s an excuse or a reality. The bottom line is that they see this as an opportunity to save money.”

As long as Medicare stays the course, private payers and Medicare programs usually don’t budge, sources say.

“Medicare’s the trend setter,” Hildebrandt said. “That’s why our efforts are focused on Medicare.”

Providers like Tobia aren’t sure what to do about the 9.5% cut to power wheelchairs.

“Maybe there are things we can no longer do,” he said. “Maybe we’ll have to start charging for things.”