Study Says Gap-Filling Problematic
Washington CMS’ gap-filling methodology, if it is used to set prices for power wheelchair codes, could result in an average payment reduction of 25 percent,
Washington
CMS’ gap-filling methodology, if it is used to set prices for power wheelchair codes, could result in an average payment reduction of 25 percent, according to a study conducted by Muse & Associates and commissioned by the American Association for Homecare.
The gap-filling formula is used by CMS to price new DME codes by estimating what the price would be if it were on the Medicare fee schedule in 1987. That price is then trended forward to 2004 using actual increases in fee schedule payments.
The study recommends that CMS use 1992 as the historic pricing year for all power wheelchair equipment, since much of the technology for today’s wheelchairs was developed after 1987. The study found that of the power wheelchair products that were examined, only nine had historic price information before the year 2000. For an executive summary of the study, visit www.aahomecare.org.
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