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by: Liz Beaulieu - Wednesday, December 30, 2009

Three out of five claims for standard and complex power wheelchair claims did not meet Medicare documentation requirements during the first half of 2007, the Office of Inspector General (OIG) states in a new report. Those claims accounted for $112 million of the $189 million in total improper payments allowed for that time period.

The OIG based its report on a review of 375 claims for standard and complex power wheelchairs.

Other findings in the OIG’s report:

  • Two out of five claims had multiple errors;
  • Suppliers submitted incomplete documents almost three times as often as they failed to submit requirement documents;
  • Complex power wheelchair claims had a higher documentation error rate than standard power wheelchair claims; and
  • Standard power wheelchair claims submitted by low-volume suppliers had a higher documentation error rate than those submitted by high-volume suppliers.

(Anyone else find this last finding especially interesting? Does it mean that a provider like The Scooter Store has the cleanest claims?)

The OIG recommends that CMS improve compliance with documentation requirements by conducting additional reviews of claims; recovering overpayments and considering further actions against suppliers that do not meet requirements; and increasing education for suppliers and prescribing physicians about requirements. Additionally, the OIG recommends that CMS take action on the sampled claims found to be in error. CMS concurred with the OIG’s recommendations.

To read the OIG’s report in full, go to: http://oig.hhs.gov/oei/reports/oei-04-07-00401.pdf.

Liz Beaulieu

by: Liz Beaulieu - Tuesday, December 29, 2009

OK, so I don't know how the logistics of this would work out, but woudln't it be really cool if you were an RTS or ATP, or an OT or PT, and you attended one of these wheelchair Tai Ji workshops with clients who use wheelchairs? Or you learned enough about it that you could offer mini-workshops yourself?

That would be really cool.

The workshops are given by Dr. Zibin Guo, a University of Connecticut and Harvard trained medical anthropologist and Tai Ji master who has developed new specialized programs for people with limited mobility, including people in wheelchairs. He says Tai Ji improves their body and soul.

If you don't believe Dr. Guo, listen to Carolyn Rayborn, who was paralyzed waist down in a car accident (she's featured in the video at about 4:40). She says wheelchair Tai Ji "has helped me to regain my life and confidence."

There are several wheelchair Tai Ji workshop dates for 2010 on Dr. Guo's Applied Tai Ji Web site, including Atlanta on Jan. 30, Dallas on March 13 and right here in Portland, Maine on April 17.

Maybe I'll go. That would be really cool.

Liz Beaulieu

by: Liz Beaulieu - Monday, December 28, 2009

I get quite a bit of flack from my colleagues for using this blog to promote various industry Webinars and teleseminars (They think it's a cop-out). But I want to give NRRTS's teleseminar series for 2010 a shout out for two reasons:

  • Who's around this week to read this blog, anyway?
  • If you are around, many of you, like me, are getting ready to fill your 2010 day planners with appointments, and before you book yourself solid, you may want to take a look at what NRRTS has to offer. It's good stuff, especially if you need to meet NRRTS and/or RESNA continuing education requirements and don't have the budget to travel to CELA or Medtrade/Medtrade Spring.

From Jan. 19 to June 17, NRRTS has 12 teleseminars scheduled on everything from "Consumer Self-Advocacy: The Key to the Future of Complex Rehab" to "Anatomy and Disease Process for the RTS." All the teleseminars are scheduled from 5 p.m. to 7 p.m. EST for your convenience. Best of all, they're free this year for NRRTS registrants and only $20 for friends of NRRTS (FONs)—a $160  value. All others must pay $35.

Download the complete schedule from NRRTS's Web site. Look for "New from NRRTS."

Liz Beaulieu

by: Liz Beaulieu - Tuesday, December 22, 2009

Have you seen "Avatar," the new science fiction blockbuster movie from James Cameron, the creator of the Aliens and Terminator series? If you work with wheelchairs users, you might want to.

The main character in the movie is a young man named Jake Sully, a Marine and a paraplegic. Long story short: Sully, who uses a manual wheelchair,  joins a top-secret program that allows him to embody an Avatar and live an able-bodied life in another world called Pandora.

There are some pretty telling and touching scenes in the movie related to Sully and his disability. Here are a few:

  • Sully says his biggest motivators for joining the program are "being free" and having a "fresh start."
  • Sully says his spine could be fixed, but that "takes money," and he doesn't have any. (That's nothing new, huh? Money keeping a person with a disability from living the most independent life possible.)
  • When Sully wakes up on a stretcher as his Avatar in Pandora, he doesn't wait to stand up. He's held down by medical professionals and tethered to IVs, but he scrunches his toes,  jumps to his feet and, with a wide grin, starts walking then running.

While watching the movie, I wondered how wheelchair users would view it. I've seen a few blogs and articles by wheelchair users addressing this very topic. For David Morrison, for example, the movie got him thinking:

The idea that one can enter a world where there are no limits, no strange looks, no disabilities of any kind, and simply be yourself had me awe struck. Granted, technology may not be at that level for several years, but is this concept at all possible? What do you think?

Toward the end of the movie, Sully makes a decision to reside on Earth or Pandora. Which do you think he picks?

Liz Beaulieu

by: Liz Beaulieu - Friday, December 18, 2009

As you know from my last blog, the industry's first effort to preserve the first-month purchase option for standard power wheelchairs failed, because the CBO says the amendment that the industry crafted and Sen. Arlen Specter introduced would only save $200 million over 10 years (it needs to save $800 million).

Now a new amendment has been drafted that outlines an across-the-board cut phased in over a four- or five-year period, says Seth Johnson, vice president of government affairs for Pride Mobility Products.

We're waiting for a CBO score to see what the reduction would need to be for the amendment to be budget neutral," he said. "The amendment is drafted, but there's a blank where the reduction should be. The language is pretty straightforward. If we get back a CBO score that's reasonable, it could easily be introduced."

The amendment's best chances for being introduced are when leaders in the Senate and House of Representatives meet to combine their healthcare reform bills, Johnson said.

We've been told that it could be considered as part of the conference process in January," he said. "If it's budget neutral, they can just exchange one provision for another. You're not changing the dollar value involved."

Liz Beaulieu

by: Liz Beaulieu - Thursday, December 17, 2009

As we reported in our HME NewsWire on Monday, the "clawback" alternative for standard power wheelchairs crafted by the industry and proposed by Sen. Arlen Specter, D-Pa., has been killed by the Congressional Budget Office (CBO).

But not all hope is lost, according to AAHomecare, which just sent out this bulletin to members:

In an effort to preserve the first-month purchase option, an alternative was discussed on the last joint CRMC-State Leaders’ call which would propose an across-the-board rate cut or CPI freeze for standard power Group 1 and Group 2 chairs.  Senate allies have informed AAHomecare that this cut cannot be phased-in over a 10-year period but would require a 3- to 5-year phase-in period instead.  The CRMC council and AAHomecare guest members on the call agreed to request that the cut apply to Group 1 and 2 base chairs only and not to options and accessories.  The group agreed that if more than 3.5% cuts are required to reach budget-neutrality, then the CRMC will reconvene to discuss.

Liz Beaulieu

by: Liz Beaulieu - Wednesday, December 16, 2009

December is a time to take stock. With that in mind, I used Google Analytics to find out the most viewed rehab story on our Web site for 2009:

Rehab: Separate but not equal?, published in the March 3 HME NewsWire and viewed 2,111 times.

I'm not surprised. NCART's efforts to create a separate benefit for complex rehab has been a steady source of stories and blogs for me this year. It's interesting to note that when I wrote this story earlier this year, stakeholders made a point to tell me it was a long-term project. It is, but there's been quite a bit of progress since then. In my most recent story published in last week's NewsWire, Don Clayback states that he and other members of a steering committee hope to have a plan that details changes to coding, coverage criteria, payment methodology and provider qualifications completed next month. From there, they'll develop a legislative and regulatory strategy.

So what was the second most viewed story? "Wheelchair repairs: CMS addresses service fees," published in the April 13 NewsWire and viewed 1,997 times.

Liz Beaulieu

by: Liz Beaulieu - Tuesday, December 15, 2009

The ROHO Group, a manufacturer of wheelchair seat cushions, was the driver behind an article in the Belleville News-Democrat today about how healthcare reform would negatively impact local businesses. The manufacturer tells the newspaper that its 250 employees could be affected by certain provisions in the bill, including one that calls for the Government Accountability Office (GAO) to implement a competitive bidding program for manufacturers of medical devices and supplies. Because of the customized nature of its seat cushions, ROHO feels it would suffer in a competitive bidding program where standardization (and the cheaper products they produce) is king. The article contained the following stats, which were interesting:

  • Dave McCausland, senior vice president of planning and government affairs, estimated that total U.S. expenditures for wheelchair seating each year is roughly $100 million to $120 million. Globally, it is about $300 million.
  • Total Medicare expenditures last year for durable medical equipment prosthetics, orthotics and supplies manufacturers was approximately $12 billion. Less than $20 million of that went for adjustable, skin protection seating, which primarily are the products The ROHO Group manufactures.

Be sure to read the comments at the bottom (always entertaining, if not interesting)!

Liz Beaulieu

by: Liz Beaulieu - Monday, December 14, 2009

rhb-nsm-van1Nashville, Tenn.-based National Seating & Mobility (NSM) has taken its show on the road. Earlier this month, President and CEO Mike Ballard left the company’s corporate offices in a “Mobility RV” outfitted with wheelchairs and other equipment and headed west toward California. His plan: To stop at NSM branches to deliver education to therapists and physicians; perform wheelchair clinics; and, in general, raise awareness of the rehab industry. “We think this is an excellent method of getting the word out to all of our constituents,” stated Ballard in a release.

Liz Beaulieu

by: Liz Beaulieu - Thursday, December 10, 2009

This is an interesting exercise:

Jackie Jackson, a New Jersey social worker with multiple sclerosis, has launched a statewide initiative to educate municipal officials about making facilities more friendly to people with disabilities, according to a Dec. 8 article in mycentraljersey.com. As part of her "accessibility tour," Jackson encourages officials to "roll with me" through various facilities, including city halls and libraries.

After taking the tour recently, Plainfield Mayor Sharon Robinson-Briggs told a reporter for mycentraljersey.com:

"I do see some areas that we need to improve. I saw a lot of obstacles today I didn't see before."

Keep up the good work, Jackie!

Liz Beaulieu

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