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It's no fun being a power wheelchair provider these days

It's no fun being a power wheelchair provider these days

It's no fun being a standard power wheelchair provider these days. As if competitive bidding and the elimination of the first-month purchase option weren't wreaking enough havoc on cash flows and bottom lines, now there's this: Providers in three states report that a "bug" in CMS's system is preventing them from getting paid at all.

Here's a shortened bulletin from AMEPA that went out this morning:

"Bugs" in system cause denials for contracted Power Wheelchair providers

Contracted Power Wheelchair providers in the Charlotte, Miami and Orlando Competitive Bidding Areas (CBAs) have reported multiple beneficiary denials on the K0823, Group 2 Standard Power Wheelchairs.

In all of the reported cases, the denial code of CO-108 was issued. The explanation for the denial is "Payment adjusted because rent/purchase guidelines were not met."

According to a representative from CIGNA, the Medicare Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for the Southeast Region, the problem was caused because the system is not recognizing that the patient is in a Competitive Bid Area. On January 1st, the removal of the First Month Purchase Option changed the type of sale in Power Wheelchairs from a purchase to a rental in all areas, except those in the Round One CBA's.

The CIGNA Representative mentioned that they can see in the system that the provider is a bid winner, but as for beneficiaries residing in a CBA (where the First Month Purchase Option is still applicable), the "bugs" have not been worked out of the system yet.

For contracted supplier David Warren, from First Choice Medical in Matthews, NC, that excuse is unacceptable.

"It is bad enough that we have to try and survive with an eleven hundred dollar cut in reimbursement, but how does Medicare expect us to continue to service patients, when they are not even paying our claims."

So far First Choice has received the CO-108 denial code on all three claims that were sent in January, and they are awaiting an answer on seven other claims that are still in process.

Warren explained, "I can't just tell Pride and Invacare, 'Sorry I can't pay you for 10 Powerchairs, because I got denied by Medicare', they will cut me off. I can't tell these beneficiaries, 'Sorry, I can't send a technician to retrain you, adjust or fix your Power Wheelchair, because Medicare denied it', I am now responsible for these patients."

Warren added, "In addition to the financial strain, I now have to deal with calls and complaints from patients who received denial letters from Medicare. They fear they will lose equipment they rely on. The patients think we are doing something wrong. It hurts our reputation with physicians. The entire process is very aggravating."

Liz Beaulieu


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