Dropping Medicare like a hot potato


It’s been rough going for the mobility providers I’ve spoken to this month.

Provider Scott Scobey says he’s ready to give up on mobility altogether. 

“I wouldn’t provide another power wheelchair for all the tea in China,” he said.

Scobey, president of Low Country Mobility in Savannah, Ga., says it’s not worth staying in business when auditors are holding up cash flow on legitimate claims.

“I’m being killed by RAC audits,” he said. Scobey has had four in the last six months—including claims that have passed muster with ADMC. 

“You’ve got to go through the process, eventually get to the ALJ, and win your money back,” said Scobey. “But it’s not even about ‘Did this person need this chair?’ It’s about them saying a date stamp is missing when it’s not.”

He's extremely frustrated by the auditors' tactics. One claim got kicked back because the home evaluation wasn’t dated—when the LCD doesn’t even require that, he said. 

Scobey says he’s planning move on to something else in the industry—and it will be something that Medicare is not involved in at all. 

If it’s not audits, it’s the demo, other providers say. 

Provider Craig Rae says three doctors in his Salisbury, N.C. area in the past two weeks have decided not to do power mobility for Medicare altogether because of all the denials they’ve seen. 

Peggy Walker says most denied prior authorizations are for technicalities. 

“We’re seeing very picky denials,” said Walker, billing specialist for U.S. Rehab. “They always seem to find something.” The problems are in Jurisdiction B more than anywhere else, she said. The demo states there are Michigan and Illinois. 

Meanwhile, provider Cory Baker said he’s had Scooter Store patients ask him to make repairs while the provider has been out of commission. 

“We’ve had a few contact us,” said Baker, compliance officer at Abilene, Texas-based Choice Medical Supply. “They’re reaching out to anybody in the phone book.”

Will Baker get paid for helping these patients?

“Most likely not,” he said. 

With providers and doctors feeling discouraged enough to drop out of Medicare altogether, how long can the providers who are left take care of patients out of the kindness of their hearts? And who’s going to be left to take care of patients when they can’t anymore?




My previous company made the decision to stop doing PMD's through Medicare shortly after the elimination of the 1st month payment option in 01/2011.  I've spoken with many providers who have done the same, and the ones that are still providing chairs aren't giving nearly the options that they used to.  I think CMS policy has basically put a stranglehold on providers who are reaching that point where they say "We've come as far your direction as we can".

When my old company closed it's doors, My wife and I started a small tech service business for HME.  We don't deal with insurance at all and we're definitely more limited in who we can work with.  The other side of the coin is that we don't have to compromise our customer service, our overhead is basically nill, and although we don't generate nearly as much money, we're both much happier and the customers we do work with are as well.  I see similiar things happening as more bad policy moves forward ie: competitive bidding, ineffecient audit process etc.  In the end as always, the end user pays the price........