RE: New CMS Guidelines
CMS is relenting on some of its new coding and billing guidlines for power mobility devices.
CMS is relenting on some of its new coding and billing guidlines for power mobility devices.
In just two months' time, the Centers for Medicare and Medicaid Services has changed its policy again and decided that it shouldn't limit its reimbursements to rehab equipment companies as drastically as it first put forth in its new policy. The decision specifically targets, but is not limited to, Group 3 or complex rehab equipment used most often by high-level SCI's and others with severe disabilities. These billing codes and reimbursements have been increased in acknowledgement of the higher prices of such life-enhancing equipment.
CMS claims that its intent with the new guidelines was never to limit consumer's access to necessary equipment. According to CMS spokeswoman Ellen Griffith, "People are being told 'You won't get this kind of wheelchair' and that's not true. You're going to be able to get the wheelchair you need. We are determined to pay right because we owe that to the taxpayer and we owe that to the beneficiary."
Industry insiders are still wary of any CMS program that decreases payments for specialized, high-end rehab equipment. CMS has the perception that they are paying too much for power chairs because utilization has increased and the government doesn't want to pay more. "That's the scary thing - the government wants to pay less," says the vice-president of government relations for Invacare. "This is a hugely dramatic change in the industry, for everybody. Most consumers can't afford to cover the differential."
Although CMS has changed some of its guidelines, it won't budge on the stance that every power mobility device provided by Medicare should be for in-home use only.
