Editor’s Note: If you are seeking repairs or service for a Scooter Store-supplied scooter or power wheelchair, please click HERE for help.
A Centers for Medicare & Medicaid Services (CMS) announcement saying other providers can now step in to repair power mobility devices originally supplied by The SCOOTER Store is no remedy, according to several industry DME and complex rehab technology organizations who were asked about it.
On the surface, the CMS announcement appeared to address a serious problem for Medicare beneficiaries who’d been supplied power wheelchairs and scooters by The SCOOTER Store. The New Braunfels, Texas-based power mobility device (PMD) supplier closed its doors in September.
The SCOOTER Store had been in CMS’s crosshairs for years, accused by the agency of billing Medicare for PMDs that weren’t medically justifiable. When The SCOOTER Store finally shut down, beneficiaries in possession of capped-rental PMDs from the company had nowhere to turn for service and repairs.
In a Jan. 16 edition of MLN Connects, CMS said that The SCOOTER Store had transferred ownership of capped-rental PMDs to corresponding beneficiaries on Oct. 24.
“Medicare beneficiaries now own this equipment,” the bulletin said. Medicare would therefore pay for repairs to those PMDs “if the contractor determines that the repairs are reasonable and necessary in accordance with Medicare regulations and program instructions.”
eMobility published news of the Medicare bulletin in its Jan. 21 edition, and provider responses were swift and indignant.
Could Good Samaritan Providers Be Putting Themselves at Risk?
A DME and complex rehab technology provider from New Hampshire wrote, “What about the potential problem that [The SCOOTER Store] provided these PMDs when the patient didn’t qualify? How does that leave the vendor that provides the repair? … Now as a provider, [if] I do a repair, doesn’t that expose us to a take-back on the repairs?”
A mobility provider in North Carolina pointed out, “Our experience has been that in the vast majority of requests for SCOOTER Store repairs, the original paperwork is rarely available.”
He added, “Is it not true that to comply with standard guidelines for repairs, that a provider must first obtain all of the original documentation justifying the equipment? And even then, if an auditor should come back three years from now and determine that the SCOOTER Store or a physician had a clerical error anywhere in the original paperwork, that the payment for the repair will be required to be paid back?”
Underscoring the uphill battle in acquiring sufficient medical documentation to back up repair work, the North Carolina provider added, “Last week, a patient called whose doctor moved to Trinidad.”
Organizations: Repair “Solution” Doesn’t Address the Problem
Those sentiments and concerns were echoed by several industry organizations that contacted Mobility Management following the CMS announcement.
“Although on the surface this sounds like the issue is fixed, it is not,” said Robert G. Miller, acting executive director of the Jersey Association of Medical Equipment Suppliers (JAMES).
While Miller acknowledges that the issue of “who owns the power base until the end of the capped-rental period, which previously could never be achieved in many cases” has been resolved, he said a number of issues still exist.
“The repairs do not only need to be medically necessary, etc., the overall power mobility base needs to meet that criteria as well,” Miller said. “Many clients of [The SCOOTER Store], in our experience, did not qualify for the benefit in the first place. They used the unit for outside use, malls and shopping, etc. Many of the clients that wanted repairs to those units admitted to us they never intended to use it indoors, and many couldn’t even fit in their homes effectively. Now they want battery replacements, new tires, etc.”
As a result, Miller believes providers who perform repairs to equipment originally supplied by The SCOOTER Store are putting themselves at risk of having to repay Medicare later.
“If the power unit is being audited and/or recouped currently, the repairs still will not qualify,” he explained. “The supplier that provides these repairs is taking a chance on each and every repair unless they do their own due diligence and completely re-qualify the patient. And, as you know, that includes a face-to-face visit as required by CMS. For repairs of this dollar volume, the risk clearly outweighs the benefit if you do not undertake that step. Suppliers need to make sure their claims are audit proof, and these claims will be subject from the beginning.”
Kim Brummett, senior director of regulatory affairs for the American Association of Homecare (AAHomecare), said of the bulletin, “AAHomecare is aware of this recent clarification, and although we appreciate the additional guidance, it will not assist in allowing Medicare beneficiaries access to needed repairs” because of the documentation and justification issues cited by other organizations and individual providers.
“AAHomecare met with CMS and other industry groups — including NCART, United Spinal and the ITEM Coalition to name a few — to discuss these exact issues and presented a list of items that would need to be addressed in order to ensure patients could obtain needed services,” Brummett said. “In addition, AAHomecare has sent a letter to Joel Kaiser at CMS in follow-up to the meeting, with no response.
“We continue to encourage providers to obtain all necessary paperwork prior to performing any service on wheelchairs that were not obtained from the same provider.”
Part of a Widespread Issue for Beneficiaries
Don Clayback, executive director for the National Coalition for Assistive & Rehab Technology (NCART), said about CMS’s repair bulletin “Unfortunately, this is much ado about nothing.” He explained, “This does not address the core barrier to Medicare beneficiaries getting their wheelchairs repaired: That is the fact that there needs to be proof of medical necessity for the power wheelchair itself. If the supplier did not sell the person the wheelchair, the beneficiary has to go through the whole evaluation process again.”
Clayback added, “While this addresses The SCOOTER Store customers, what about other beneficiaries that have been ‘abandoned’?”
Alluding to the October meeting with CMS that was attended by AAHomecare, United Spinal Association, the ITEM Coalition and others, Clayback said the organizations discussed the problem of suppliers going out of business or no longer offering repair services, thus leaving Medicare beneficiaries with no way of obtaining repairs from the supplier that originally sold the equipment.
Clayback said at that meeting, the organizations suggested a solution: “Policy changes are needed to allow the beneficiary to sign an ‘abandonment attestation statement’ when they are no longer able to get service so that they can start over and receive services from another supplier. This ‘restart’ policy would be along the lines of the changes CMS made regarding payments for oxygen equipment rentals.”
Another barrier for Medicare beneficiaries who need equipment repairs is the documentation requirement currently in place.
“Onerous documentation requirements come into play when a beneficiary looks to get a power wheelchair repaired by a supplier other than the company who originally provided the wheelchair,” Clayback said. “The new supplier must try and secure medical necessity documentation from the original supplier — which can take months or in many cases is impossible — or the beneficiary must go back through the whole evaluation and documentation process with their physician.”
In the October meeting, Clayback said industry representatives suggested, “As in the case of Medicaid and private payors, allow a qualified supplier to provide and bill for a wheelchair repair solely based on a detailed written order signed by the physician.”
Medicare’s controversial competitive bidding program, Clayback added, has “reduced the number of suppliers, and the reduced payment rates have worsened the issue of limited access to repairs that existed before competitive bidding.”
Clayback said there have been “historic problems” in this area due to the “‘disincentives’ that exist that prevent a supplier from being able to provide repairs — wide variety of products, required inventory and infrastructure, required trained staff, billing challenges, low payment rates and negative profit margins.”
At the meeting, industry organizations suggested removing repair parts codes from the competitive bidding program, “which would restore traditional rates and allow all suppliers to provide all repair parts,” Clayback explained. “That will at least get access back to pre-competitive bidding levels.”
Clayback and Brummett indicated their organizations were waiting to hear back from CMS at press time.
Also at press time, CMS and Joel Kaiser, the director of the CMS division of DMEPOS policy, had not responded to multiple Mobility Management requests for comment.
If you are a Medicare beneficiary seeking service or repair work for a Scooter Store-supplied power wheelchair or scooter, click HERE for help.