PWC crackdown ‘paralyzes’ dealers

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Sunday, February 29, 2004

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WASHINGTON - Medicare’s renewed dedication to strictly enforcing coverage criteria that limits power wheelchairs to beneficiaries who are bed- or chair-confined has begun taking its toll on providers.
C. Bachenheimer

Region B, for example, has initiated “considerably more” claim reviews since CMS and the DMERCs issued coverage “clarification” for power wheelchairs in December, Region B Medical Director Adrian Oleck told HME News last month.

“If the patient can walk either without assistance or with assistance from an ambulatory aid like a walker, than a power wheelchair is not medically necessary,” Oleck said.

Prior to the December clarification, Region B applied a “less restrictive” interpretation of who could qualify for a power wheelchair, Oleck said.

In February’s HME News Poll, 51% of 102 provider respondents indicated that “too many” of their power wheelchair claims had stalled since Medicare issued the clarification. Previously, coverage criteria for power wheelchairs hinged on whether or not a patient needed power mobility to move about his home - not whether he was bed or chair-confined, the industry claims.

“It has paralyzed the industry over the past few weeks,” Cara Bachenheimer, Invacare’s vice president of government relations, said early last month. “People are not providing power wheelchairs to needy beneficiaries because they are afraid that they will get reviewed and get denied.”

Medicare officials say that enforcing the bed- or chair-confined criteria standardizes power wheelchair coverage among the four DMERCs. Tim Hill, CMS’s chief financial officer, described the effort as not so much new policy, as the industry claims, but as “new scrutiny” by officials who had grown lax in monitoring regulations in place since 1997.

“We had seen a spike in power wheelchair spending,” Hill told the New York Times in January. “It was the prudent thing to do.”

The industry disagrees, and on Jan. 30 it announced a new coalition - Restore Access to Mobility Partnership (RAMP) - and embarked on an all out lobbying effort to force CMS to rescind the clarification.

Rather than a clarification, the bed- or chair-confined criteria is new policy intended to rein in utilization and stamp out, as much as possible, fraud and abuse, say industry watchers.

Additionally, any new clarification should include input from the industry, clinicians and consumer groups, Bachen-heimer said.

“If they went through an honest period of due process and gave us a chance to provide evidence, and ultimately they decided this is the way it should be, they would be wrong and would have consumer groups upset, but that is the judicial way of going about change,” said Dan Meuser, president of Pride Mobility Products.
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