'We haven't decided how we're going to handle it'

Sunday, December 31, 2006

WASHINGTON - In the days after CMS implemented new codes, coverage criteria and pricing for power mobility devices, providers were still taking stock of how their businesses and patients may be affected.
"We tried to push out as many power wheelchairs as we could by Nov. 14," said Tyrrell Hunter, president of Majors Mobility in Scarborough and Topsham, Maine. "Anything new--we haven't decided how we're going to handle it yet."
CMS implemented the new policies Nov. 15. Before they went into effect, however, the agency revised them several times, largely due to pressure from providers and manufacturers, who said the changes may put them out of business and hurt patients.
Despite the revisions, providers and manufacturers still have concerns, particularly with pricing. The agency's new pricing for PMDs still represents significant cuts across-the-board, but particularly in Group 2, which comprises geriatric or consumer mobility (CMS's latest pricing revisions came in mid-December. See page 27).
At least for the next few months, several providers indicated that they would provide PMDs on a case-by-case basis.
"We'll see clients, get authorizations, make sure they meet the coverage criteria and then sit down and determine whether we can afford to provide them with equipment or not," said Sydney Gubin, who owns the Seating Center in Palm Springs, Calif.
Numerous providers have adopted a wait-and-see approach, because they believe CMS may further revise the policies.
"(CMS) is continually winging it," Gubin said. "Until you really know what you have to deal with, how are you supposed to figure anything out? It's like being told that the only fast food chain in town is moving on Tuesday. Then you hear it's not moving for another month. Oh, and by the way, the price of fries is going up, but the price of burgers is going down, and you have to have a note from your doctor to get a Coke."
CMS will likely adjust pricing for two power wheelchairs in Group 2: K0823 and K0825, according to Seth Johnson, vice president of government affairs for Pride Mobility. The agency may also remove expandable controllers from the basic equipment package, allowing providers to bill for them separately, he said.
But CMS isn't the only wild card in the post-Nov. 15 rehab world. Providers are also waiting to see what changes manufacturers may make.
"Are we going to get cheaper chairs from them?" asked Kim Brummett, vice president of contracting and reimbursement for Advanced Home Care in Greensboro, N.C. "Will we use more offshore chairs?"
Providers won't have a firm grip on the PMD changes for at least a month--maybe longer.
"There's so much variance in rehab," said Jim Greatorex, president of Black Bear Medical in Portland, Maine. "You have 10 different profits for 10 different sales. Until you go through all of those different scenarios--that's when you'll start finding problems."