Monthly Archives: January 2016

CMS Issues Unreasonable Billing Instructions for Accessories Used With Complex Power Wheelchairs

January 25, 2016

CRT Providers and Manufacturers,

Late this past Friday CMS posted instructions to Medicare providers for billing accessories used with Group 3 Complex Power Wheelchairs in light of the “one year delay” passed by Congress at the end of 2015.  The text of the announcement is as follows:

Implementation of Section 2 of the Patient Access and Medicare Protection Act (PAMPA)

The Patient Access and Medicare Protection Act (PAMPA) was recently signed into law.  Section 2 of PAMPA mandates that adjustments to the 2016 Medicare fee schedule amounts for certain durable medical equipment (DME) based on information from competitive bidding programs not be applied to wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs.  Group 3 complex rehabilitative power wheelchair bases are currently described by codes K0848 through K0864 of the Healthcare Common Procedure Coding System (HCPCS).

Although this change is effective January 1, 2016, changes to the Medicare claims processing system cannot be implemented any sooner than July 1, 2016.  Until these changes are implemented, payment for these items will be based on the adjusted fee schedule amounts.  Suppliers can submit claims for these items with dates of service on or after January 1, 2016, but payment will be based on the adjusted fee schedule amounts.  On or after July 1, 2016, suppliers can adjust previously paid claims with dates of service on or after January 1, 2016, to receive the full fee schedule amount.

Additional information, including a list of HCPCS codes for accessories affected by this change, as well as further instructions regarding the submission and processing of these claims, will be provided in the coming months.

This published billing policy violates the intent of the year-end Congressional legislation and unfairly places significant burdens on CRT providers which will compromise their ability to provide continued access to the complex rehab wheelchairs used by people with high level disabilities.

We are reaching out to CMS and to our Congressional champions to point out the unreasonableness of paying providers at reduced payment amounts for the next 6 months.  This is what the year-end legislation was to prevent.  It is also unreasonable to then require providers to have to “resubmit” 6 months of claims after July 1, 2016 to get paid the proper amount.

We will supply further updates as we have more information.

On a related note, we have been meeting with our Congressional champions to develop the CRT strategy and messaging for 2016 to obtain permanent legislative solutions to protect access for people with disabilities.  To kick off this important year we will be holding a “CRT Legislation Update” call for CRT Stakeholders on Tuesday February 9th at 4 PM ET to review our planned activities.  Additional call-in details will be provided next week.

What does NCART do?

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If you’re new to our webpage, or you’ve been here for a while but just haven’t had a chance to really poke around, you might be wondering what NCART is all about. In today’s blog, we’d like to cover a little about what we stand for and what we do.

NCART stands for National Coalition for Assistive and Rehab Technology. We ensure that those with significant disabilities have access to Complex Rehab Technology (CRT) by working with the users, the clinicians, the physicians and legislators at all levels of government.

Complex Rehab Technology (CRT) includes specialized power or manual wheelchairs that are configured to an individual’s unique medical needs. The technology also includes items such as positioning seats, standing devices or gait trainers. They are evaluated, configured, adjusted and programmed to meet the medical needs of the individual using them.

However, as any clinician, supplier, caregiver, or wheelchair user can attest, obtaining these medically-necessary devices is becoming more challenging. Issues regarding coding, coverage and payment are mounting all across the board, whether it’s in regards to private payers or payers at the state and federal levels.

NCART works to make sure access to CRT is upheld. We approach payers and lawmakers to advocate for the needs of individuals with significant disabilities and medical conditions and work to establish the policies that will help, rather than hinder, their access to medically-needed devices.

While we’ve seen a great victory recently with the passage of S. 2425 and a one-year delay to CMS’s plan to apply competitive bid pricing to accessories used with Complex Power Wheelchairs, there is still more we can do in 2016. Keep visiting our website or reading our blog for more updates.