Provider: Compliance costs us accounts

Playing by the rules for manual wheelchairs, walkers and canes has cost Brian Brice, an outside sales representative for Jeff's Surgical, at least 10 accounts, he says. To provide the equipment, Brice tells physicians and therapists that Jeff's Surgical needs chart notes, ideally ones that show they have followed the required algorithm for determining medical necessity. He reminds them that the algorithm, part of a national coverage decision (NCD) released almost two years ago, applies not only to power wheelchairs and scooters but also to manual wheelchairs, walkers and even canes. The problem is not all providers ask physicians and therapists to supply chart notes for the latter, Brice said. "They ask us, 'Why should we provide you with notes when this company's not asking for them?'" he said. "We tell them it's Medicare's guidelines, but they take the easy way out. I can't blame them for not wanting to do the notes. They don't have time." According to Brice, the Edison, N.J.-based Jeff's Surgical is the sixth largest supplier of walkers in the country. Brice, alone, provides 60 to 80 manual wheelchairs a month, he said. Some providers stray from the rules even more, Brice said, by writing the notes that physicians and therapists should be writing. "That's so illegal," he said. Dr. Paul Hughes, the medical director for jurisdictions A and B, said he isn't surprised some providers "don't have a good understanding or appreciation" that the requirements in the NCD, with the exception of the face-to-face exam, are applicable to all mobility devices. "I wish everyone was as honest as the day is long, but this is America, and there's always going to be people who are trying to get away with the minimum," he said. "That's a competitive environment." Brice can take some comfort, Hughes said, that in a post-payment audit, providers who aren't playing by the rules could be at risk. After losing so many accounts, however, little comforts Brice. "I talk to other sales reps who work for competing companies and they say, 'You and I both know Medicare won't check the notes for manuals,'" he said. "I'm thinking, even if they do, it could be years, and in the meantime, the providers who are doing things legally are at risk of losing more and more business."