Wheelchair providers react to new demo

YARMOUTH, Maine - Wheelchair providers may be in favor of the prior authorization phase of the new PMD demo--if they can survive the prepay review phase.

One major concern for providers about prepay reviews: the potential cash flow problems.

"It's going to be a tough one," said Tim Pappert, manager of Spring Hill, Fla.-based Mrs. Mobility. "We can't wait three to six months to be paid for everything. It could potentially put us under."

CMS's PMD demo, which kicks off Jan. 1, calls for three to nine months of prepay reviews for PMDs in seven states, followed by a prior authorization process for the rest of a three-year period.

At least with the prior authorization process, which will be completed by physicians, providers will have some assurance of payment.

"I think it's a terrific idea," said Randy Freeman, owner of Fort Worth, Texas-based Mediwell. "We're in a very intense audit situation now and the rules keep changing. It's really frustrating, so I think this could potentially be a very positive thing for the industry--knowing up front whether you're going to get paid or not."

Franklin Trammell, president of Matthews, N.C.-based Carolinas Home Medical Equipment, is more cautious about providers' prospects under the demo. If it's implemented the way some audits are now, it could force him out of the PMD business, he said.

"If they're looking for fraud and abuse that's one thing, but if they're looking just to be picky, that's totally different," said Trammell. "It could be ugly. Hopefully it won't be."

Some providers may not feel the effects of the demo as strongly as others, even if they're in one of the affected seven states. Provider Jene Sego said, as a contract supplier in a competitive bidding area, many of his claims come under prepay review already. His advice: Don't put out a wheelchair without having all your ducks in a row.

"We make sure every bit of documentation is very strong and it's all in our hands before any kind of PMD leaves our facility," said Sego, owner of Titusville, Fla.-based Sego's Home Medical Equipment.