Take care with manual chairs

YARMOUTH, Maine - Kerry Fitzpatrick, president of Gouldy Medical Services in Mount Holly, N.J., feels left out. The national coverage determination (NCD) that took effect about a year ago pushed providers who supply power wheelchairs and scooters to the forefront. Gouldy's Medical doesn't provide that equipment. Nearly 40% of its product mix is manual wheelchairs, canes, crutches and walkers. But as far as Medicare is concerned, product mix doesn't matter: The NCD determines appropriate and necessary equipment for all mobility assistive devices--not just power chairs and scooters. "The focus tends to be on providers of more expensive equipment at the expense of providers of bread-and-butter equipment," Fitzpatrick said. "The fact that the requirement applies to all equipment has been underreported and underappreciated." Since the NCD was released in May 2005, Gouldy Medical has had to revamp its "entire paperwork flow," including placing more emphasis on combing through physician notes, Fitzpatrick said. "There's significant documentation required for a simple cane," she said. "A customer used to walk through the door and hand us a script." But many providers and physicians still aren't aware that the NCD applies to all mobility assistive equipment, Fitzpatrick said. (Fitzpatrick stays up-to-date, she said, by spending the first hour of every workday visiting the Web sites of various agencies, including the Region A DMERC, the SADMERC and CMS, and attending seminars like Medtrade.) Cara Bachenheimer, vice president of government relations for the Elyria, Ohio-based Invacare, agreed that the same "education gap" that providers of power wheelchairs and scooters have complained about also applies to lower-tech mobility equipment. The stakes are just as high, too: "In the event of an audit, auditors will look for documentation in the medical record that relates to the criteria (outlined in the NCD)," even for manual wheelchairs, Bachenheimer said. While Fitzpatrick would like to see more attention brought to the plight of providers of lower-tech mobility equipment, being left out may not be such a bad thing, she said. "(CMS) is going after the power wheelchair providers right now, because they represent the big bucks," Fitzpatrick said. "But they have to pay for the prescription drug plan somehow, and they're going to start looking more closely at everything."