Proposal would 'destroy' power wheelchair benefit

Thursday, February 24, 2011

WASHINGTON - Wheelchair providers have some pretty strong words for a proposal in the president's budget for 2012 that would require prepayment reviews for all power wheelchairs.

"If what they're saying is that I'm going to go ahead and get all my stuff together, deliver the chair and submit a claim and then they're going to ask me to send in all my documentation and they're going to determine whether to pay or not, that's going to destroy the benefit," said Scott Scobey, president of Low Country Mobility in Savannah, Ga. "You can just throw it away."

The administration believes that requiring prepayment reviews for all power wheelchairs would save $240 million over 10 years. The proposal comes on the heels of a new policy that eliminates the first-month purchase option for standard power wheelchairs and makes the equipment a 13-month capped rental item.

Providers say it already takes about 45 days to get paid for a standard power wheelchair and about 60 days for a complex power wheelchair. If the proposal were to become a reality, it would take at least 60 and 90 days, respectively.

"It's going to take providers who are already in a cash crunch and make their situations a lot worse," said Rob Huddler, owner of Mobility Rehab Products in Finksburg, Md. "It's also going to limit access."

Plus, providers are skeptical of the government's (or its contractor's) ability to review claims, especially those for complex power wheelchairs.

"I'm a physical therapist and I have a doctorate's degree," Huddler said. "I've found that reviewers aren't qualified to justify the denial of a piece of equipment. A licensed practical nurse doesn't understand the different components of a complex power wheelchair to meet mobility needs."

Instead of a prepayment review, providers would like to see the administration consider requiring prior authorizations for power wheelchairs. Many state Medicaid programs do this already.

"The difference with a prior authorization is that we get all the documentation together and submit it and they review it for medical necessity before we deliver," said Michael Bird, president of Marshall Mobility Plus in McAllen, Texas. "That way we have something we can hang our hat on."

So why is the administration chasing a prepayment review vs. a prior authorization?

"It's easier for a reviewer to just deny something rather than actually look at it and make a decision ahead of time," Bird said.