Unbundling trips up providers

Friday, November 22, 2013

YARMOUTH, Maine – Provider Brent Bradshaw says Round 2 of competitive bidding has sparked a disturbing trend: contract suppliers billing patients for brake attachments for walkers that CMS has already paid for.

CMS last month cautioned providers about “unbundling” walkers and brake attachments. When providers sell walkers with brake attachments (E0141, E0143 and E0149), reimbursement is for the whole unit, the agency stated.

Bradshaw, president of Durable Medical Equipment Inc., in Austin, Texas, welcomed the clarification.

“This makes competitive bidding winners bill at the price they agreed to,” he said. “With reimbursement for Round 2, they can bill at $70, and they’re billing the patient $95. They’re shifting the cost to the beneficiary.”

Since the clarification, however, provider Dave Mills has been leery of providing walkers to Medicare beneficiaries.

“This is something we don’t want to be in violation of,” said Mills, co-owner of Chesapeake, Va.-based First Choice in Homecare. “The reimbursement is already almost less than we’re paying.”

Billing expert Andrea Stark says the recent unbundling errors for walkers and brake attachments are probably accidental for many providers.

“This is more than likely an education issue that is cropping up,” said Stark of MiraVista. “A lot of providers are attempting to do upgrades, but this is frequently done incorrectly.”

To do it correctly, Stark says providers should offer patients equipment that suits their medical needs, and then offer different equipment with enhanced features as the upgrade.

“You have to start with what is medically necessary, and upgrade from there,” Stark said.


Providers really need to understand the codes they are bidding on! As I understand the process, when you win a bid, you're obligated to provide the items to all beneficiaries who qualify.  Why would anyone accept a reimbursement rate that "is already almost less than we’re paying”??