AMEPA Report: ‘Bugs’ Cause PWC Denials for Round 1 Winners

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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