CMS defies accessories mandate

WASHINGTON - Stakeholders were flabbergasted last week when CMS issued billing instructions for accessories for Group 3 power wheelchairs.

In the instructions, CMS says it will use an adjusted fee schedule based on competitive bidding rates for these accessories,despite a law passed in 2015 delaying that change for one year. The reason: The agency says it can't adjust its claims processing systems for at least six months.

“CMS has implemented these kinds of payment changes for doctors and other entities countless times,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “There have been tons of year-end bills, and there's never been this kind of lag in implementation. It completely obviates the point of the law.”

CMS says providers will have to resubmit claimson or after July 1, 2016, to get paid the proper amount.

While stakeholders concede that CMS may need 30 to 60 days to update its system, they say 180 days is unreasonable.

“Providers are already absorbing the cuts for complex manual wheelchair accessories and now they're going to have to absorb the cuts for power wheelchairs,” said Don Clayback, executive director of NCART. “They'll get paid that eventually, but to do that, they're going to have to resubmit all those claims. It creates an administrative nightmare for providers and it creates a burden on CMS's part, too.”

There's also concern that the six-month delay sends mixed messages to private insurance companies, which often follow Medicare's pricing guidelines.

“They're getting a mixed signal as to whether this is implemented or not,” said Bruce Bayes, owner of Largo, Fla.-based Custom Mobility and an NCART board member. “They're going to be lagging behind in whatever decision is made and everyone's looking for reasons not to pay.”

Since the announcement, stakeholders have been in communication with CMS, as well as their champions in Washington, D.C, to hash out a more reasonable timeline.
“(Congress) seems to understand complex rehab and the value it provides,” said Bayes. “There just seems to be a lack of understanding on the part of CMS.”