ATLANTA — In late February, the DME MACs issued a new
billing and payment policy for wheelchair repairs based on
standardized labor times that left providers with a number of
questions. Last week, the MACs answered with an
target="_blank">FAQ on the policy, which took effect April
1.
Among the questions the MACs addressed:
Question: If a beneficiary refuses to bring their
equipment to the supplier location, can they be charged a fee for
this service?
Answer: No, Medicare's payment for repairs,
i.e., parts and labor, is all-inclusive. There is no separate
payment for travel time, service charges, fuel surcharges, etc. On
an assigned claim, suppliers may not charge a beneficiary for these
costs. On a nonassigned claim, the beneficiary will be responsible
for the difference between the submitted charges for the repairs
and the amount Medicare pays.
Question: The reasonable useful lifetime for durable
medical equipment is 5 years. If an item that is less than 5 years
old needs to be repaired because of "wear and tear" (rather than a
specific incident) and a thorough evaluation reveals that the cost
to repair the equipment exceeds the cost to replace the equipment
would Medicare consider payment for a replacement piece of
equipment?
Answer: No, according to Medicare statute,
during an item's reasonable useful lifetime, payment can only be
made for repairs up to the cost of replacement.
Question: If the equipment has been repaired on several
different occasions, is in need of repair again, and no single
repair has exceeded the cost to replace the equipment but the
cumulative repair costs will exceed the replacement cost, would
Medicare consider payment for a replacement piece of
equipment?
Answer: No, according to Medicare statute,
during an item's reasonable useful lifetime, payment can only be
made for repairs up to the cost of replacement.
Question: What percentage of repair to replacement cost
would Medicare consider acceptable to deem the purchase of a
replacement item more cost effective?
Answer: There is no provision for replacement
due to "wear and tear" prior to the end of the item's useful
lifetime.
Under the billing policy, one unit of service equals 15 minutes.
A table in the policy notice contains repair units of service
allowed for commonly repaired items. Read the
target="_blank">policy notice on the Cigna (Jurisdiction C) Web
site.
