Providers walk repair tightrope

YARMOUTH, Maine--When rehab providers go to a beneficiary's home to repair a wheelchair, they don't get paid for their drive time or gas. That hasn't mattered all that much - until now.

After a 9.5% reimbursement cut Jan. 1, some rehab providers gave beneficiaries a choice: We'll go to your home for a fee - anywhere from $50 to $75 - or you can bring your wheelchair to us. They say they no can longer afford to make the trips for free.

Money got even tighter April 1, when providers began billing for repairs using standardized labor times. To repair or replace a battery on any wheelchair, including a complex wheelchair, for example, they must now bill only two units of service, with each unit representing 15 minutes of labor.

But charging beneficiaries trip fees continues to be a grey area, industry sources say.

Medicare considers costs like drive time and gas to be included in reimbursement. That means, technically, providers can bill neither Medicare nor beneficiaries for those costs.

As a result, providers have the following two options, industry sources believe: They can accept assignment and bill Medicare for the repair, eating any losses related to drive time, etc.; or they can bill non-assigned with an ABN and charge the beneficiary upfront for both the repair and trip fees.

Neither option is a real win-win, rehab providers say.

“What it comes down to is, if I'm a provider, I have to ask a patient to bring their wheelchair in or I have to charge them $50 to $75 upfront just to look at it, never mind charging them for the part and then another trip fee to actually do the repair,” said Cindi Petito, owner of Seating Profiles in Jacksonville, Fla. “It's that or lose money.”