New Medicare Policy Aims to Alleviate Repair Problems

A new policy from the Centers for Medicare & Medicaid Services (CMS) could finally bring some relief to Medicare beneficiaries whose durable medical equipment (DME) needs repairs, as well as to the DME suppliers who are trying to help them.

Effective Nov. 4, 2014, CMS has instructed Medicare DME MACs to alter their current documentation requirements for DME that needs repairs and is owned by beneficiaries.

"If Medicare paid for the base equipment initially, medical necessity for the base equipment has been established," CMS said in change request 8843, dated Aug. 1. "Therefore, contractors are to only review the necessity of the repair and make a payment determination."

While CMS made no specific mention of power mobility devices (PMDs) in the policy change, Medicare beneficiaries who were issued scooters or power wheelchairs from The Scooter Store have become increasingly desperate since the embattled supplier shut down last fall.

Thanks to Medicare policies that define such PMDs as capped-rental items, beneficiaries whose vehicles were still under rental contracts between The Scooter Store and Medicare were left in limbo. Medical documentation and customer records that had led to PMD issuance in the first place were also largely inaccessible.

In January, Medicare announced it would pay for repairs to Scooter Store-issued PMDs performed on or after Oct. 24, 2013, because on that date, the defunct supplier had "transferred titles to capped durable medical equipment rented to Medicare beneficiaries." That transfer gave ownership of the vehicles to the beneficiaries.

But that move provided little real relief to beneficiaries. Other DME suppliers who made repairs to Scooter Store-issued vehicles found that their repair claims were red flags to Medicare contractors looking for reasons to conduct audits. Increasingly, those suppliers turned away Scooter Store beneficiaries because repair claims were so difficult to get paid.

Medicare's national competitive bidding program, now underway in most parts of the country, put a further squeeze on beneficiaries by sharply limiting the numbers of suppliers available to do repair work.

Confused and frustrated beneficiaries and their families phoned and e-mailed PMD manufacturers, wheelchair component manufacturers, industry organizations, the media and their members of Congress.

And coming up on a year after The Scooter Store's close, those beneficiaries could be a step closer to finding a significant resolution. The CMS bulletin noted that altering policy was necessary "due to the changing environment occurring in the DMEPOS industry and the difficulties Medicare beneficiaries are having in locating suppliers to repair equipment when the original supplier's documentation for the equipment is not available."

In an Aug. 25 bulletin to members and stakeholders, Tom Ryan, CEO of the American Association for Homecare (AAHomecare), said, "From patient complaints to members of Congress, it has taken many voices to help CMS understand that the current state of medical equipment repair is unacceptable. This new guidance is a step in the right direction towards fixing the convoluted and confusing documentation requirements."

The AAHomecare bulletin added that the organization was reviewing the Medicare announcement "for its impact on the industry, however upon first review, providers will now be able to repair equipment, such as power wheelchairs, without the burden of finding the original medical necessity documentation from the original provider, many of whom are now out of business."

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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