PWC criteria restricts access but ...

Friday, April 30, 2004

BALTIMORE - For Georgie Blackburn, the shifting sands of Medicare’s K0011 power wheelchair policy stopped moving at CMS’s Open Door Forum on power wheelchairs March 31. And now she wonders whether they’d ever been moving at all.
G. Blackburn

“What came across to me was that this policy has not changed,” said Blackburn, director of compliance at Blackburn’s in Tarentum, Pa., who went in person to hear CMS and DMERC officials discuss wheelchair policy. “It never has changed, it is not likely to change and that bed or chair confinement has always been there.”

Blackburn doesn’t like how restrictive Medicare’s coverage guidelines are for power wheelchairs. In fact, she believes that limiting the benefit to those who are totally non-ambulatory is fundamentally wrong. But she does believe that Medicare, despite the recent rancor, has been consistent about its power wheelchair coverage guidelines.

From the advent of the Wheeler Dealer fiasco in Houston, through the Dec. 9 clarification and then CMS’s notice to Congress in March that it planned to rescind that clarification, Blackburn’s power wheelchair business has remained steady.

“I can’t say we have noticed an increase in denials due to the Wheeler Dealer issue,” she said. “The only denials I have noticed have to do with some of the HIPAA quirks.”

The company employs five CRTSs and provides power wheelchairs and durable medical equipment from two locations in New York to patients in both Regions A and B.

Blackburn’s principal take-away from the Open Door Forum has to do with documentation.

“The onus is on us to make certain that that medical justification is written in the medical record of the physician and that we obtain a copy of that and put it in our files in advance of providing the chair,” she said.

Blackburn is comfortable moving forward with the policy as she understands it. If the Open Door provided a glimpse of anything, it was the degree to which she is responsible to her doctor.

“We have to make sure they understand the policy and we scrutinize our patients to make sure we are providing the right motorized product to a patient who is medically justified,” said Blackburn.