CRT providers wrangle with repairs and prior auth exemption

WATERLOO, Iowa – Complex rehab technology (CRT) providers continue to face persistent challenges with documentation and billing for wheelchair repairs, according to Dan Fedor of U.S. Rehab, who addressed the issue at the recent VGM Heartland Conference.

Fedor, director of reimbursement and education for U.S. Rehab, a division of VGM & Associates, said repairs remain one of the most common operational pain points for providers – accounting for roughly 30% of his daily communications with members.

“This keeps being a problem,” he said.

Fedor presented alongside Jason Smith and Rick Spiegel of MK Battery during a session titled “Don’t Lose YOUR Shirt on Wheelchair Repairs.”

Documentation gaps tied to staffing pressures

In most cases, the root cause of billing issues is operational, Fedor said. Technicians are often under pressure to move quickly from one repair to the next.

“They’re understaffed and overstretched – it’s not easy to find good CRT techs as they are in demand,” he said. “And they don’t want the patient not having their wheelchair repaired timely, so they just keep moving on to the next customer as quickly as they can.”

That fast-paced environment can trigger a chain reaction across the organization. Without proper documentation, billing teams lack what they need to submit clean claims – ultimately leading to denied claims or write-offs.

To address the issue, providers must prioritize ongoing education to ensure the techs are fully trained on CRT repairs and proper documentation for repairs, Fedor said.

“There needs to be training and more training,” he said. “Techs need to realize if they don’t take the time to document properly, the company can’t get paid.”

Confusion over prior authorization exemptions

At the Heartland Conference, CRT providers were also trying to untangle a new program that exempts certain providers from prior authorization requirements if they meet specific claim approval thresholds.

In early March, DME MACs notified qualifying providers of their exemption status and instructed them to submit an opt-out form if they wished to continue using prior authorizations. The deadline for responding was May 26.

“I got calls from members: What do I do?’” Fedor said. “I told them, ‘If you got a letter you’re exempt from prior authorizations, but you have to opt out of the exemption to continue submitting prior authorizations.’ It was like a double-negative; it was confusing.”

Most CRT providers prefer to continue submitting prior authorizations for power wheelchairs as a risk mitigation strategy, Fedor said.

“Everyone I know who provides complex power mobility – they want to continue to be able to submit prior authorizations,” he said.

Prior auth exemption: What happens next?

What does it mean if a supplier received the exemption letter and didn't opt out of the exemption by May 26? It means they selected the prior auth exemption and can no longer submit prior authorizations to traditional Medicare for one year, says Dan Fedor.  

Jan. 1, 2027

• Exempt suppliers get an Additional Documentation Request (ADR) for 10 claims to check compliance.
• Suppliers must respond to the ADR within 45 days with the requested documentation; failure to do so will result in claim denial.
• There must be 10 paid claims by November 30 to stay exempt.
  • If there are not 10 paid claims, exemption ends.

April 2027

• CMS sends notices:
  • Continued Exemption if you still qualify.
  • Withdrawal of Exemption if you don't.
• Suppliers can opt out by April 30 if you want to keep sending PARs.

June 1, 2027

• New exemption cycle starts.

FMI: https://www.cgsmedicare.com/jc/pa/exemption-process.html.