Separate benefit for complex rehab: Heard at Medtrade


During an update at Medtrade on the separate benefit for complex rehab, attendees were given the chance to ask questions of  steering committee members, including Don Clayback, chairman of the committee and executive director of NCART. I always find it interesting to hear what providers are concerned about. Here are a few of their questions and Clayback's answers.

Will the benefit include additional accreditation requirements for complex rehab providers?

Clayback says if providers are accredited already, they may have a few extra requirements to meet, but there shouldn't be any significant "additional burden."

Will the new benefit address the lack of funding for the time it takes a complex rehab provider to supply a complex wheelchair? It involves evaluation, followup, etc.

Clayback says they seek to "formally record" all the services involved in providing a complex wheelchair. Also, they'll be looking for an increase in the allowable to better reflect those services.

Why not have separate codes for products and services?

"It's too risky in this environment," Clayback said.

CMS doesn't understand that providing a complex power wheelchair is less about completing a sale than managing a case. It's ongoing.

Clayback advised attendees not to lose sight of the progress the industry has already made in recognizing complex rehab. The product category was exempted from competitive bidding (Group 3, anyway), and it was exempted from the elimination of the first-month purchase option. "We're not starting from scratch," he said. "There's buy-in on the difference of these products."

Speaking of the elimination of the first-month purchase option...

During another update—this one a legislative update—Rita Hostak of Sunrise Medical pointed out that CMS anticipates providers will try to move beneficiaries from standard to complex power wheelchairs to avoid the elimination of the purchase option. "So documentation is going to be really important" for complex rehab providers, she said.

Liz Beaulieu


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