It’s a New Year…Are We Getting a Break?

Welcome to 2008. Are you ready? Many people are wondering what this year will bring. As much as I wish I could see into the future, we all know that there are no guarantees. By all means, what we talk about today may be very different tomorrow. With this in mind, let’s talk about what we think may happen this year. We are getting close to the three-year anniversary of the release of the national coverage determination for mobility assistive equipment (MAE). Of course, we think of this and we think power mobility devices (PMDs). But remember this was for all MAE — including manual wheelchairs.With that said, it’s now manual wheelchairs’ turn.

New Codes Coming

Yes, you can expect to see new codes for manual wheelchairs rather soon, and expect to see them implemented by the end of the year. The question we still have is how many codes will be given to cover all manual wheelchairs. There have been rumors of up to 70, but then I have also heard half of that number, if not lower. My personal policy when it comes to guessing is don’t bother. Wait until we see them; if we are given a chance to comment and it is needed, then start speaking up.

No matter how many codes we are given, your company will again have to start learning a new way to bill these products. As I learned with PMDs, this is not always easy. You may have people who have been masters at billing, but when these kinds of changes come along, they need to remember they are atthe same starting point as everyone else.

Expect to see some similarities between the new manual chair codes and the current PMD codes. The setup may be different, but we will be given the ability to separate bariatric products. We will likely have a “basic equipment package,” where certain items will be included with the base. And manufacturers will be required to put their products through specific tests prior to receiving code verification.

The development of new codes is not necessarily a concern — they are needed. My worries are with pricing (allowables) and the policy itself. We will get new allowables, which means we may not behappy with them. Again, never forget to be a part of the battle, if a battle is needed.

Credentials Are Crucial

Something else that is upon us is the assistive technology supplier (ATS) requirement for the supplying of certain rehab equipment. The effective date is April 1, 2008.

Editor’s note: After this article was written, but before this issue printed, the medical directors of CMS’ Program Safeguard Contractors (PSCs) rescinded the assistive technology practitioner (ATP) portion of this requirement, which would have required an ATP to evaluate a client who is being considered for a rehab power chair. The change of heart is thought to be an acknowledgement by CMS that not enough ATP-credentialed therapists would be ready by April 1. Therefore, the present rehab evaluation policy will instead remain in place. The revised evaluation policy will be incorporated into a future local coverage determination. For more information, see the CMS Update story in this issue’s MMBeat.

At the end of the day, this ATS credentialing requirement will likely go through, which I believe is ultimately a good thing. Remember, as a rehab industry we have fought for others to understand that we are not an “out-of-the-box” business. Rehab does take training and experience, both for the providers and the referrals.

No Code, No Funding

We do know for sure that the testing requirements for PMDs have changed (effective Jan. 1, 2008). This is important because if a product does not meet the testing requirements, it will not qualify forHealthcare Common Procedure Code System (HCPCS) code verification — meaning if there is no code, there will be no reimbursement by Medicare. The new requirements regard where the tests must be performed. The only way this change affects you as a provider is whether or not products you choose to order will be code verified. The manufacturers will be the ones with the headaches.

Keep in mind that this change is for all new code applications. It does not affect products already coded unless a manufacturer makes any name changes, model number changes, etc. — any change at all to a previously coded item. Manufacturers will then have to reapply and will be responsible for meeting the new testing requirements. In essence, there is no “grandfathering” of the older products.

Also new for 2008: A specific code has been developed for a specific rehab product — code E2227. The formal definition is “Manual wheelchair accessory, gear reduction drive wheel, each.” This code was specifically developed due to a request from Magic Wheels. We had seen success in reimbursement with the K0108, code but this should assist with other insurance payors and should result in easier processing. This code went into effect January 1, 2008.

A Year Filled with Change

Lastly, just to keep us on our toes and to be certain we know our alphabet: There is a name change and new acronym for one of the Medicare contractors. Effective April 1, 2008, the Program Safeguard Contractors will have a new name. They will be called Zone Program Integrity Contractors or ZPICs. The companies will still be the same and serve the same functions; it’s just new terminology and a new acronym for us to learn.

With all this said, I am sure this is just the tip of the iceberg. Keep your eyes and ears open. More importantly, if you “hear” rumors but you have not seen specifics in writing, ask around and do your research. Rehab can still be a successful business — we just have to be smart and never forget our clients deserve the best we can give.

This article originally appeared in the January 2008 issue of Mobility Management.

About the Author

Claudia Amortegui is president of The Orion Group, a Colorado-based consulting company that specializes in DME reimbursement issues and assists suppliers with billing and Medicare questions.

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