CMS: We Will Pay PWC Accessories at Reduced Rates Till July

Despite late-December legislation that provided a one-year delay in scheduled funding cuts for Group 3 power wheelchair accessories, the Centers for Medicare & Medicaid Services (CMS) said it intends to pay according to its reduced fee schedule until July.

President Obama signed S. 2425, the Patient Access & Medicare Protection Act, into law on Dec. 28. That bill included a one-year delay of Medicare funding cuts to accessories used on complex rehab technology (CRT) power wheelchairs. Those controversial funding cuts were based on Medicare competitive bidding-derived pricing, which CRT advocates contend is illegal because CRT has been legislatively excluded from CMS’s DME competitive bidding program.

On Jan. 22, CMS issued a statement saying it would use its competitive bidding-based fee schedule for CRT power wheelchair accessory claims from Jan. 1 through June 30. Claims from July 1 onward would be paid at the proper amounts.

In its statement, CMS blamed logistics for the inability to pay at the proper rate for the first six months of the year.

“Although this change [i.e., the funding-cut delay] is effective January 1, 2016, changes to the Medicare claims processing system cannot be implemented any sooner than July 1, 2016,” CMS stated. “Until these changes are implemented, payment for these items will be based on the adjusted fee schedule amounts.”

To be fully and properly reimbursed, providers will have to resubmit affected claims starting on July 1 and ask CMS to pay according to the full fee schedule.

That, says NCART Executive Director Don Clayback, puts a great deal of stress on providers.

In an interview with Mobility Management, Clayback said, “There are two real issues. First, the providers are now going to get paid less than they should for the next six months, which presents some real cash-flow problems. And then the second issue is once July 1 hits, they’re somehow going to have to go back and submit half a year’s worth of business to get paid the proper amount. Both of those present burdens on the provider. [CMS is] saying yes, we’re going to adjust the payments, and we’ll pay you at the proper amount, but we’re not going to do that for six months, and then we’re only going to do it if you resubmit, in essence, six months’ worth of claims.”

In its statement, CMS said providers would be responsible for re-filing claims if they wanted to receive full payment. CMS’s statement did not mention any compensation, such as interest paid on the outstanding money, to offset the extra work providers will have to do.

In a Jan. 25 bulletin to stakeholders, Clayback said CMS’s plan to reimburse at lower rates is “unreasonable” and said it “violates the intent of the year-end Congressional legislation and unfairly places significant burdens on CRT providers, which will compromise their ability to provide continued access to the complex rehab wheelchairs used by people with high-level disabilities.”

Clayback said NCART had already reached out to both CMS and members of Congress to try to get further details and a fair resolution.

CMS’s statement said it would provide “further instructions” in “upcoming months.” But that does little to solve the issues that providers of CRT wheelchairs and accessories are already facing in light of CMS’s intentions to pay the lower fee schedule amounts.

Because the Washington, D.C., area and many portions of the Eastern United States were still contending with the after-effects of winter storm Jonas as the week started, Clayback said CMS’s payment situation was still evolving, and he advised providers to stand by until more information is available.

“This just came out Friday, and because of the snowstorm, we need to get a response from our Congressional champions and see if there’s anything we’re missing through our conversations with CMS,” he explained. “I would say to stay tuned for our next update.”

About the Author

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

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