Providers may need to rethink accessories

Friday, October 16, 2015

WASHINGTON – With just two months left to reverse CMS’s plan to apply competitive bidding pricing to accessories for complex power wheelchairs, industry stakeholders say providers need to have a Plan B, should legislative efforts fail.

“I think the first thing providers need to do is recognize the impact this is going to have on their Medicare business,” said Don Clayback, executive director of NCART.

In July, Rep. Lee Zeldin, R-N.Y., introduced a bill to prevent CMS from applying bid pricing to accessories for complex power wheelchairs. At press time, the bill, H.R. 3229 had 30 co-sponsors.

NCART has developed a downloadable “Wheelchair Accessory Impact Calculator” to help providers estimate the reimbursement cuts for the HCPC codes that will likely be affected by the change.

“CMS hasn’t published the final pricing, so we had to make some estimates, but providers can use those estimates to help them create a contingency plan,” said Clayback.

Provider Doug Westerdahl is ahead of the game. Based on utilization data for 2014, he estimates his company stands to lose $288,000, approximately 11.4% of its overall Medicare revenue.

“We’ll lose money on all of these products,” said Westerdahl, president of Rochester, N.Y.-based Monroe Wheelchair. “Without question, we will have to discontinue supplying some of these items.”

Because other payers often follow Medicare’s lead, this could be an even bigger problem.

“Medicare sets the standard,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “That’s why this issue is so gargantuan. For your typical complex rehab provider, Medicare is not the primary payer; it’s state Medicaid, workers compensation and private pay. Once Medicare adopts these lower rates for complex accessories, all of these other payers are going to lower their rates.”


Just wondering, What is your company doing to prepair for these cuts in reimbursment?  Will you cut staff?  Outsource billing?  Eliminate product lines?    No sure that I know what we will do yet.