Repairs: A ‘good win’ but more to do

YARMOUTH, Maine – Complex rehab stakeholders could start using a “basic order for repair” on Jan. 1 to meet Medicare’s requirement to show continued need. 

Previously, Medicare required that providers show continued need in the medical record within 12 months of a repair. 

“This is huge,” said Dan Fedor, director of reimbursement and education for U.S. Rehab, a division of The VGM Group. “This means an order covers repairs and continued need for the whole year. You only need one per year.” 

Stakeholders had been pushing CMS to drop the requirement to help speed up repairs and address concerns that consumers are not getting served in a timely manner, spurring a number of right-to-repair bills in different states. 

The requirement, as it was previously interpreted, often meant that users would have to schedule a visit with their physician just to get the repair process started. 

“There were a lot of challenges with that,” Fedor said. “Many physicians wouldn’t document need without seeing the patient, so just for a repair, they might have to schedule a face-to-face exam. It was very time consuming and labor intensive for an item already paid for and approved.” 

The change is a “good win” for the industry, but Fedor says there’s still more to do. Repair and service issues are on the list of priorities for NCART and other stakeholders for 2023. 

“It’s a multi-faceted issue,” said Wayne Grau, executive director of NCART. “It deals with everything from prior authorizations to continued need to reimbursement. Our folks don’t get reimbursed for travel time to and from a home; they’re not reimbursed for evaluations, just the wrench time. We have to educate payers this doesn’t work.”