Rehab industry: 'We're truly under attack'

Sunday, August 13, 2006

WASHINGTON - CMS gave the rehab industry two more pieces of the coding puzzle last week when it released a product classification list and preliminary pricing information. The two documents, however, failed to give the industry a clearer picture of the coding system that CMS plans to implement Oct. 1, sources said.

For starters, the product classification list, which places more than 100 power wheelchairs and scooters into six groups of codes, is "replete with errors," one source said. The main problem: CMS placed several products into the wrong codes.

"We have conveyed the need for changes to (Dr. Doran Edwards, the SADMERC medical director)," said Seth Johnson, chairman of AAHomecare's rehab council and vice president of government affairs for Pride Mobility Products. "We're very concerned."

Unfortunately, CMS used the product classification list to determine preliminary pricing information, "mixing up" the codes even more, industry sources said.

CMS further irked the industry by including median retail prices from "several reputable Internet sites" in its pricing information. What CMS appears to be saying to the industry is, "Your pricing is way off guys," said one source.

"We're truly under attack," the source said.

The industry knew that CMS had been researching power mobility prices through the Internet and other payers, but the big question now is whether "the agency believes online pricing truly represents the cost of doing business with Medicare," Johnson said.

"It's scary," said Cara Bachenheimer, vice president of government relations for Invacare. "An Internet sale is a cash transaction and a drop-ship to the door. A Medicare transaction involves filing a claim and performing various services."

The pricing information also includes median wholesale prices and MSRPs submitted by manufacturers. For several power wheelchairs, the difference between the median MSRPs and median Internet prices is more than $3,000.

The industry has until Aug. 25, 2006, to submit comments on the pricing information, and a fee schedule will likely follow soon after that. The industry's already working with Edwards to modify the classification list, said Johnson and Bachenheimer.

Additionally, more than 50 suppliers, clinicians and physicians have sent letters to CMS, asking for a 90-day transition period for the new codes. For a seamless transition, the industry needs time to educate physicians and update its billing systems, Johnson said.

The industry expects the DME MACs to release a local coverage determination on the new codes before Aug. 15, because by statute, they must give a 45-day notice before implementing the codes.