Uncertainty

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Friday, April 30, 2004

Editor, HME News

We went to press with our April issue before we’d learned that CMS intended to retract its power wheelchair clarification and so believed that our lead news headline last month, “CMS won’t budge on K0011,” was as erroneous as the Chicago Tribune headline that declared Thomas Dewey (Dewey wins!) as victor over Harry Truman in the 1948 presidential election.

The fact of the matter, as anyone who listened to the CMS Open Door forum on power wheelchairs can confirm, is that CMS is not inclined to budge on an interpretation of medical coverage guidelines that has sent claims for power wheelchairs plummeting in Region C and prompted about 700 individuals to tune into the forum, whether by phone or in person. The prevailing sentiment is simple: there’s still not enough resolution to give mobility providers the security they need to do business.

Uncertainty prevails, not only for power wheelchairs but on so many other fronts that affect HME business. No one yet knows what kind of oxygen cut the OIG is going to recommend given their recent analysis of reimbursement. That report has been drafted and is now making its way through channels. Another report that’s likely to enter the power wheelchair fray is a report now in the hands of CMS, prepared by the OIG, which looks at both pricing and coverage. The contents of that report were scheduled to be revealed at a hearing into power wheelchair fraud and abuse conducted by the Senate Finance Committee on April 28.

There’s no telling what CMS plans to do if reimbursement for respiratory meds stands at 106% of the average sales price. Some action will have to be taken. In a March SEC filing, Apria said it would start transitioning out of the neb-meds business if the reductions are implemented as currently interpreted.

There’s no getting around the desirable demographics that have fueled this industry. If only everything else were as apparent.

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