Industry, Patients: ‘Stop Mobility Pre-payment Review — Now'
Provider and consumer advocates call on Congress to cease implementation of power wheelchair program.
- By David Kopf
- Dec 08, 2011
The American Association for Homecare, HME providers and patient advocates are urging Congress to halt the implementation of the pre-payment review demonstration project (www.cms.gov/CERT/02_Demonstrations.asp) for power wheelchairs, saying the program would jeopardize patient access to needed equipment and foster significant job losses in several states.
Starting Jan. 2, the Centers for Medicare and Medicaid Services’ demonstration project would require pre-payment review for all Medicare claims for power wheelchairs in California, Florida, Illinois, Michigan, New York, North Carolina and Texas. This will affect nearly half of all Medicare beneficiaries who require power mobility, AAHomecare reports.
Stakeholders representing clinicians, people living with disabilities, and providers of power wheelchairs have been shaking off their initial shock and starting to organize a response since, the demonstration’s Nov. 15 announcement. The announcement comes at a particular bad time for mobility providers, who already have been trying to overhaul their businesses to conform to the January 2011 removal of the 13-month purchase option for standard power mobility. Wilson labeled CMS’s decision to launch the program in the wake of providers’ struggles to adjust to the rental policy “inconceivable.”
“We are calling on Congress to stop this demonstration project before it prevents older Americans and people living with disabilities from receiving medically required mobility equipment and causes irreparable harm to providers of home medical equipment and services,” said AAHomecare President and CEO Tyler Wilson. “Members of Congress should be worried about the impact of this program on many of the most vulnerable people in our society.
“CMS moved unilaterally with no notice to Congress, Medicare beneficiaries, or the power mobility community,” he added. “Their actions will ration medically necessary items and services to Medicare beneficiaries and will actually increase health care costs. Studies show that beneficiaries with limited mobility who don’t receive power wheelchairs require more medical treatment, additional skilled services and may even have to be admitted to expensive care facilities and nursing homes.”
The United Spinal Association (www.unitedspinal.org) stated the demonstration project will further endanger people living with disabilities who need mobility assistance.
“The process for receiving a power wheelchair has already become burdensome for Medicare beneficiaries and their physicians,” said Paul Tobin, president and CEO of United Spinal Association. “There are parts of the country where Medicare patients have to do business with reluctant providers who are hundreds of miles away. This demonstration project will make it harder for them to receive the wheelchair they need for everyday mobility. We will be urging our members to contact their congressmen and put a stop to this project.”
For providers, the prepayment review is yet another financial burden, one that will make it impossible for many of them to continue serving Medicare beneficiaries.
“Providers simply cannot operate under this system,” said Georgie Blackburn, vice president of government relations and legislative affairs for Pennsylvania provider BLACKBURN’S. “We are already straining to deal with rental reimbursements that take 13 months. How can the government possibly expect our businesses to wait an additional three months for payments to cover the cost of obtaining the equipment? It is an unreasonable request. We don’t have access to funding that will keep our businesses operating while we wait for government reimbursements. Congress must step in and stop this.”
CMS has justified the program saying it will cut fraud, claims errors and improper payments, but industry and patient groups say the program will not only not address those problems, but ignores various recommendations to CMS for preventing errors and fraud by the industry.The root causes of the error rate in the power mobility sector are complicated rules and the subjectivity of the Medicare claims reviewers, as well as Medicare’s expensive and inefficient process for auditing claims that distorts the error rate for power wheelchairs (and other HME claims), AAHomecare says..
“We understand the need to prevent fraud and abuse,” Wilson said. “But it can’t be done through capricious actions that hurt Medicare beneficiaries and providers.”
Wilson urged that CMS work with the power mobility community to derive a system that will curtail fraud, while allowing providers to keep their doors open. He noted support for pending legislation, H.R. 3399, The Fighting Fraud and Abuse to Save Taxpayer Dollars Act (FAST Act), which would establish an electronic prior authorization program along with a clinical medical necessity template.
About the Author
David Kopf is the Editor of HME Business.