An idea that won't go away

 - 
02/07/2008

Back in 2006, CMS thought it would be a good idea to compare Medicare and Internet pricing for power wheelchairs to help create new fee schedule amounts. After an uproar from the industry, however, the agency relented.

More recently, in October 2007, the Office of Inspector General (OIG) also compared Medicare and Internet pricing for power wheelchairs. Lo and behold, it found that Medicare prices were 45% higher, on average, than median Internet prices for 28 codes. Again, the industry fought back, arguing that, unlike Internet retailers, Medicare providers must adhere to numerous standards and provide numerous services.

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Rep. Pete Stark, D-Calif., gave new life to the comparison in November 2007, citing the OIG's report in a "Dear Colleague" letter.

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It's an idea that won't go away, and it may get worse. In a recent meeting with AAHomecare and NCART, the OIG indicated that it plans to audit claims this year to calculate service-related costs for both standard and complex power wheelchairs. It sounds like the OIG wants to know if there's any beef to the industry's service cattle call.

According to an AAHomecare update on Wednesday: "AAHomecare is extremely concerned that the OIG’s upcoming efforts will not accurately quantify the full costs of providing power wheelchairs because the HCPCS coding system does not require the collection of this data. Government studies that suggest that limited services are being provided to Medicare beneficiaries who are furnished power wheelchairs could lead to another round of reimbursement cuts for power wheelchair payments."

Rightly so, AAHomecare and NCART plan to come up with their own numbers. They announced last week that they plan to develop a framework to calculate the service and overhead costs of providing a full range of power wheelchairs to Medicare beneficiaries. They also plan to develop a template that would allow providers to document their time with patients.

If you know what's good for you, you'll make it a priority to help them out.

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