Debate on DMERC Power Wheelchair Clarification Heats Up

Washington

Debate surrounding the DMERC clarification on Medicare coverage for power wheelchairs heated up last month as industry stakeholders expressed their frustrations about the policy during a CMS Home Health, Hospice and DME Open Door Forum on Feb. 18.

The controversial clarification followed CMS’ September 10-point plan, called “Operation Wheeler Dealer,” aimed at curbing fraud and abuse of the Medicare power wheelchair benefit. One of the plan’s points required the four durable medical equipment regional carriers to adopt a consistent approach to medical review of motorized equipment.

According to the ensuing clarification, which was posted on the DMERCs’ Web sites in December, power wheelchairs are covered for “patients who are non-ambulatory,” that is, those who “can only bear weight to transfer from a bed to a chair or wheelchair.” Since its posting, the industry’s power mobility sector and consumer groups have voiced worries that, among other issues, the clarification may prevent many beneficiaries who need power chairs or other motorized equipment from getting it.

At the forum, Kay Cox, president and CEO of the American Association for Homecare, expressed the association’s concerns that patients who receive medically appropriate prescriptions for power wheelchairs could be denied their use.

But Richard Lawlor, CMS’ director of the Open Door Initiative and moderator of the forum, said that claims were not being denied on a large scale, and added that suppliers were not responding to requests for proper documentation during claims processing.

Eric Sokol, director of the Washington, D.C.-based Power Mobility Coalition, questioned what he called the agency’s “hesitation to instill dialog” on the clarification.

Timothy Hill, deputy director of CMS’ Office of Financial Management, responded that the agency wants to continue dialog with interested parties, pointing out that “the issues are wide-ranging” and that CMS is taking time to understand their complexity. “It’s not in our best interest not to communicate,” said Hill. “We are trying as hard as we can.”

In related events, Sen. Michael Burgess, R-Texas, wrote HHS Secretary Tommy Thompson Feb. 18 urging him to rescind the clarification. In his letter, Burgess wrote that the “nearly 200 percent increase in Medicare claims for power wheelchairs from 1999 to 2002 … has in no doubt been driven by unscrupulous businesses that have recently entered this market, preying on seniors and defrauding the Medicare program. These particular abuses should be dealt with in a firm manner, but I am concerned that this clarification of Medicare coverage policy for motorized wheelchairs oversteps this goal.

“I urge you to rescind the December 2003 DMERC Web bulletins,” Burgess continued, “in order to facilitate a more collaborated approach among all stakeholders.”

Also fighting to rescind the DMERC clarification, HME mobility industry stakeholders have organized the Restore Access to Mobility Partnership, or RAMP, coalition. Members include the American Association for Homecare, Alexandria, Va.; Invacare Corp., Elyria, Ohio; The MED Group, Lubbock, Texas; Mobility Products Unlimited LLC, Holly Hill, Fla.; Pride Mobility Products, Exeter, Pa.; The Scooter Store, New Braunfels, Texas; and Sunrise Medical, Longmont, Colo.

82% of providers responding to a HomeCare Web poll said they are now filing HIPAA TCS-compliant claims. Another 14 percent said their claims are not yet compliant, while 4 percent said they are exempt from filing electronic claims.

For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.