Stakeholders spotlight flaws in PMD repair process

 - 
Wednesday, November 27, 2019

WASHINGTON – An upcoming review of PMD repairs by the Office of Inspector General raises the stakes for providers who are already grappling with a requirement that doesn’t always match every day realities.

That requirement: Before the date of service of a repair, providers must ensure there’s documentation from the past 12 months showing “continued need” for the wheelchair. If it’s not already in the medical record, stakeholders say it can take days to get, if not weeks if the patient needs to visit their doctor.

“That’s the rub,” said Dan Fedor, director of reimbursement and education for U.S. Rehab. “Providers want to quickly repair the chair because they don’t want the patient to be without it.’”

Prompting the OIG’s review, which is scheduled to start in the spring: Medicare paid out about $46.7 million for PMD repairs in 2018, it says.

When the patient has a progressive or non-reversible condition and uses a complex rehab wheelchair, the time it can take to meet this requirement becomes even more troublesome, stakeholders say.

“There’s a difference between someone who has a PMD who may be able to ambulate some other way in the short term vs. someone with ALS or CP who has a CRT wheelchair,” said Greg Packer, president of U.S. Rehab. “That patient absolutely needs that piece of equipment.”

Larger providers may have loaners that they can provide to patients while they obtain documentation and conduct repairs, but they don’t typically have more than a few.

“And certainly not everyone has a CRT chair with tilt and recline sitting around,” Fedor said.

Stakeholders also say there has been confusion about what’s acceptable to meet the requirement in the past. It wasn’t until a recent DME MAC council meeting for all regions that they received clarification that orders for repairs don’t establish “continued need.”

“So here we are, a few months before an audit starts—an audit that can go back seven years—and what are they going to do with those repairs that were done on orders based on unclear instruction from the DME MACs?” said Martin Szmal, founder of the Mobility Consultants. “It’s frustrating.”

Stakeholders may need to prioritize getting CMS to revise the “continued need” requirement, especially for complex rehab wheelchairs.

“This elevates the issue,” Fedor said.