Washington CMS has released its much-anticipated 2005 DME fee schedule, which includes reimbursement cuts less than many industry observers had feared.

Washington

CMS has released its much-anticipated 2005 DME fee schedule,
which includes reimbursement cuts less than many industry observers
had feared.

“There are reductions [in the fee schedule] we are not
happy to see,” said Cara Bachenheimer, vice president of
government relations for Elyria, Ohio-based Invacare, “but
they are somewhat less than we anticipated.”

According to Bachenheimer, cuts from 2004 reimbursement levels
vary widely from state to state and range as follows:

diabetic test strips (A4253): 0 to 4 percent

  • diabetic lancets (A4259): 0 to 5 percent

  • semi-electric bed (E0260): 1.6 to 16 percent

  • power pressure-reducing mattress (E0277): 0 to 7 percent

  • nebulizers with compressor (E0570): 4 to 18 percent

  • manual wheelchair (K0001): 0 to 2.5 percent

  • power wheelchair (K0011): 0 to 3.3 percent

    According to the American Association for Homecare, the maximum
    Medicare fees and capped rental payments listed for the equipment
    in 2005 are as follows: test strips, $36.94; lancets, $12.06;
    hospital beds, $140.46; air mattresses, $703.51; nebulizers,
    $16.11; manual wheelchairs, $53.27; and power wheelchairs,
    $512.29.

    Mandated by the Medicare Modernization Act, Medicare's new fees
    for these items are based on Federal Employees Health Benefit Plan
    (FEHBP) median pricing derived from an HHS Office of Inspector
    General report released in 2002. Cuts to oxygen reimbursement, also
    mandated by MMA, were to be announced this month, the agency
    said.

    “This law [MMA] brings Medicare fees down to FEHBP median
    levels,” a CMS official told HomeCare. “States
    with the highest fees came down by the highest percentage. States
    with fees closer to FEHBP levels were not reduced as much.”
    States with fees at or below the FEHBP median, he said, did not
    change.

    The calculation method “was rather equitable,” said
    Asela Cuervo of the Law Offices of Asela Ceurvo, Washington, D.C.
    “If the state fee was already at or below the FEHBP median,
    then it would be even more draconian to add another cut on top of
    that.”

    Seth Johnson, director of government affairs for Exeter,
    Pa.-based Pride Mobility Products, said the average cut for power
    wheelchairs stands at 2.6 percent, compared with 3.28 percent as
    mentioned in the OIG's report. “No reduction [in
    reimbursement] is good,” he said, “but it's less than
    what we expected. That's positive.”

    At press time, Bachenheimer said the game plan for the industry
    should be to keep pressure on Capitol Hill, as H.R. 4491 — a
    bill that would repeal the FEHBP-based cuts — remained in the
    pipeline. The co-sponsor count for the bill, drafted by Reps. David
    Hobson, R-Ohio, and Harold Ford, D-Tenn., stood at 113.

    “It's important to keep the political pressure up,”
    Bachenheimer said, “because we believe CMS responded to the
    political pressure by lessening these cuts.”

    Next year's oxygen fees will be based on another OIG report
    released in September that recommended CMS cut payments between 10
    and 20 percent. According to the CMS official, the oxygen cuts will
    be calculated the same way as the other FEHBP-based cuts: states
    with oxygen fees higher than the FEHBP median will experience
    higher reimbursement cuts.