CMS Ups Some PMD Fees

Baltimore

After a strong rally by rehab industry stakeholders — including a sharp outcry from 44 members of Congress and actor Jerry Lewis, national chairman of the Muscular Dystrophy Association — CMS upped reimbursement payments for some power chairs days before implementation of the new PMD fee schedule Nov. 15.

The agency said it raised fees for some Group 2 and Group 3 wheelchairs after reviewing comments about the new fee schedule, which was released Oct. 2. The schedule originally called for cuts as high as 40 percent for some equipment.

According to CMS Acting Deputy Administrator Herb Kuhn, industry input on product classification, errors in fee calculations and other information led to a review “to really make sure we’ve got accurate prices for these chairs.”

Fees for some of the 64 codes rose more than $1,000, and as of press time, the agency continued to recalculate fees for some wheelchairs.

To revise the pricing, CMS said it used the Aug. 23 product classification list and pricing database generated by the SADMERC. According to the agency, pricing was improved over the previous fee schedule by adding the cost of features such as seat belts, adjustable foot plates and solid-fill tires.

The agency also examined new manufacturer data; revised its formula to ensure that inflation factors were applied uniformly; and made sure heavier weight power wheelchairs were not priced lower than those of standard weight because of a lack of data.

Reaction to the revised schedule so far has been mixed.

“While not perfect, the Group 3 fees are a definite step in the right direction,” said provider Tim Pederson, CEO of WestMed Rehab, Rapid City, S.D., and vice president of AAHomecare’s Rehab Council. When the fees were first issued, Pederson said he thought about discontinuing PMD services to Medicare patients, but because of the recent revisions, he is no longer considering that action.

“I believe with careful product selection, providers can continue to provide complex rehab and assistive technology to Medicare beneficiaries,” he said.

According to Sharon Hildebrandt, executive director of the National Coalition for Assistive and Rehab Technology, “On the whole, we’re really quite pleased … We just want to verify their methodology and how they came up with the prices.”

Hildebrant said she is expecting additional information from CMS shortly, such as exactly what items were included in the calculations the agency used in the basic equipment package that was rolled into the fees.

But the Washington-based Power Mobility Coalition said although “this slight bump in price for Category 2 PMDs is welcomed, the revision does little to alleviate concerns that steep price reductions will force suppliers to close their doors and beneficiaries to have few, if any options, for quality equipment and service.”

The revised schedule still cuts reimbursements up to 35 percent, the PMC said, with a $300 increase for Group 2 chairs still representing a 25 percent drop.

According to Portland, Maine-based Black Bear Medical President Jim Greatorex, who is also an NCART board member, “I wouldn’t say that we’re living in a perfect reimbursement arena now — and there still are cuts involved with the fee schedule — but we certainly have left the brink of complete disaster.”

For more information

To view the fee schedule, visit www.cms.hhs.gov/DMEPOSFeeSched/01a_Power_Mobility_Devices.asp

To view the new LCD, visit www.tricenturion.com/content/currentbulletin_dyn.cfm