MIAMI — In a Friday newsletter, the Accredited Medical
Equipment Providers of America said Round 1 contract providers in
the Charlotte, Miami and Orlando competitive bidding areas have
reported CO-108 denials — "Payment adjusted because
rent/purchase guidelines were not met" — on standard power
wheelchair claims.
According to the report, a representative from Cigna, the
Jurisdiction C DME MAC, said the problem was caused because the
claims system is not recognizing that the patient is in a
competitive bid area. On Jan. 1, removal of the first-month
purchase option changed the type of sale in power wheelchairs from
a purchase to a rental in all areas, except those in the Round 1
CBAs.
The representative said "they can see in the system that the
provider is a bid winner, but as for beneficiaries residing in a
CBA (where the first-month purchase option is still applicable),
the 'bugs' have not been worked out of the system yet."
Here's the rest of AMEPA's report:
For contracted supplier David Warren, from First Choice
Medical in Matthews, NC, that excuse is unacceptable.
"It is bad enough that we have to try and survive with an
eleven hundred dollar cut in reimbursement, but how does Medicare
expect us to continue to service patients, when they are not even
paying our claims."
So far First Choice has received the CO-108 denial code on
all three claims that were sent in January, and they are awaiting
an answer on seven other claims that are still in process.
Warren explained, "I can't just tell Pride and Invacare,
'Sorry I can't pay you for 10 power chairs, because I got denied by
Medicare,' they will cut me off.
"I can't tell these beneficiaries, 'Sorry, I can't send a
technician to retrain you, adjust or fix your power wheelchair,
because Medicare denied it,' I am now responsible for these
patients."
Warren added, "In addition to the financial strain, I now
have to deal with calls and complaints from patients who received
denial letters from Medicare. They fear they will lose equipment
they rely on. The patients think we are doing something wrong. It
hurts our reputation with physicians. The entire process is very
aggravating."
Warren said he will bring the denial letters with him to
Washington when he attends AAHomecare's Legislative Conference next
month to meet with his congressmen and senators.
"Congress needs to know that Medicare is making it
impossible for contracted suppliers to serve patients and stay in
business."
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