Stakeholders: CMS should've worked with rehab industry

Tuesday, December 27, 2011

WASHINGTON - Stakeholders are scratching their heads over why complex power wheelchairs are included in the new PMD demonstration project. 

"Our position has always been that there really hasn't been a problem in that area," said NCART Executive Director Don Clayback. "It's really a small percentage of power wheelchair claims and it already has additional safeguards."

Complex rehab codes in the demo include all Group 2 complex power wheelchairs and Group 3 power wheelchairs without power options. These products already have protocols in place that would prevent fraud, Clayback said, such as specialty evaluations done by OTs and PTs, making the hardships created by the demo pointless. 

The prior authorization phase of the demo, however, is not as much of a cause for concern, since many Medicaid programs already have such requirements in place, said Simon Margolis, executive director of NRRTS.

"I think our registrants in NRRTS would not mind a prior authorization process because they're doing it already," Margolis said. "Prior authorization for complex rehab is not new."

Clayback said CMS should have worked with suppliers, beneficiaries and clinicians to create a new claims process for PMDs. 

"I don't think anyone in the industry is saying they shouldn't be making changes," Clayback said. "But I think (the demo) is really a recipe for disaster, because right off the bat you're taking on something significant without getting appropriate input at the front end."

At the very least, Clayback said he would like to see the demonstration delayed so the industry can take time to understand it and try to adjust business practices.