NAS Posts PWC Payment Q&A

FARGO, N.D. — Noridian Administrative Services has posted a 27-question Q&A on CMS payment rules related to power wheelchair rental.

Among the questions NAS, the DME MAC for Jurisdiction D, has received:

Short-term use

1. When standard power wheelchairs (PWCs) are provided on a rental basis, can they be covered for short-term indications?

Response: No. The change in the payment policy status for power wheelchair does not change the policy statement that PWCs are not covered for patients with short term, reversible conditions.

Change of residence

3. Is it advisable for the supplier to document in their records that they have contacted the beneficiary and confirmed that the beneficiary is able to use the PWC they are renting in their new residence?

Response: There is no requirement for a supplier to reassess the home in the event that a beneficiary changes residence.

5. If a patient with a PWC moves and their new home will no longer accommodate the PWC that they have, will Medicare pay for a new PWC?

Response: No. Medicare covers a replacement only if an item is lost, stolen, irreparably damaged, or reaches the 5 year reasonable useful lifetime. Medicare covers a different item only if there is a change in the beneficiary’s medical condition.

Repair/Replacement

11. Is there any situation in which a supplier can be paid for repair to a PWC during a capped period — e.g., if the supplier has information to indicate that the repair is required due to “malicious damage” or “culpable neglect” by the beneficiary?

Response: There can be no payment for the repair of rented items under any circumstances. Reimbursement for repairs is included in the rental payments.

If the supplier believes that a wheelchair repair is required because of malicious damage or culpable neglect by the beneficiary, the supplier can present the information to the DME MAC for investigation. If the DME MAC, in consultation with the CMS, agrees that the beneficiary is responsible for the damage, the supplier can charge the beneficiary.

14. Unique to power wheelchairs is the fact that beneficiaries often use the products outside the home as well as inside. This is generally not done with other capped rental items (e.g., hospital beds never leave the home). If a PWC is damaged outside the home, since that is not an approved use per Medicare, will the supplier be expected to repair the chair “at no charge” during the rental period?

Response: Yes, the supplier is responsible for the repair. Statutory coverage of DME requires that it be needed for use inside the home. However, if that requirement is met, the item may be used outside the home. Portable oxygen, nebulizers, walkers, canes, crutches, POVs, manual and power wheelchairs are among the many item, both rental and purchase, that are routinely used outside of the home setting. During the rental period, the supplier is expected to repair an item if the repair was related to damage that occurred either inside or outside the home. For purchased and rental items where the title has transferred, repairs are covered under the general repair rules.

Miscellaneous

19. If the beneficiary weighs 478 pounds and is renting a heavy-duty PWC coded K0827 prior to a hospitalization and/or SNF stay has a significant weight loss taking them below the 300 pounds limit for standard power wheelchairs, would a new rental episode begin upon return to home, for a standard PWC coded K0825?

Response: No. If the patient loses weight, the original wheelchair would still meet the patient’s needs. If the supplier elects to provide a lower weight capacity PWC, a new capped-rental period would not begin.

26. Is there a requirement mandating that contact with the beneficiary must be made at certain intervals to determine if a PMD meets the ongoing use requirement?

Response: If a beneficiary discontinues use of a rental DME item, the supplier may not continue to bill Medicare for that item. Although Medicare does not have specific guidelines on how a supplier should monitor and document use, each claim submitted may be subject to review. Supplier records must clearly demonstrate ongoing monitoring and use of the rental item by the beneficiary if audited.

See the full FAQ on the NAS website.