Medicare Admits Problems with Equipment Repairs

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) is changing the way it deals with medical equipment repairs. In response to complaints from patients across the nation, CMS has admitted that patients are having trouble getting equipment repaired and has released new guidance on supplier documentation for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) repair claims.

“From patient complaints to members of Congress, it has taken many voices to help CMS understand that the current state of medical equipment repair is unacceptable,” said AAHomecare CEO Tom Ryan. “This new guidance is a step in the right direction towards fixing the convoluted and confusing documentation requirements.”

CMS has instructed its Medicare Administrative Durable Medical Equipment Contractors (DME MACs) to only review the necessity of the repair when making a payment determination.

AAHomecare is reviewing the new guidance for its impact on the industry, however upon first review; providers will now be able to repair equipment, such as power wheelchairs, without the burden of finding the original medical necessity documentation from the original provider, many of whom are now out of business. If Medicare paid for the base equipment initially, medical necessity for the base equipment has been established. This guidance for repairs is to be applied to all DMEPOS equipment owned by Medicare beneficiaries as of November 4, 2014.

Specifically, contractors shall only review for continued medical necessity of the item and necessity of the repair. Contractors shall not expend resources to determine if the requirements for the initial provision of the DMEPOS item as/when it was originally ordered were met.

“AAHomecare has worked hand in hand with CMS to come to a resolution on this very important issue,” said Kim Brummett, vice president of AAHomecare regulatory affairs. “I am excited to see CMS listening and responding to industry concerns. This development is evidence of the success of collaboration.”

Medicare’s inability to arrange repairs for patients’ power wheelchairs has become widespread as a direct result of a national Medicare bidding program. The way CMS awarded contracts has driven hundreds of companies out of business and proven to be a danger to the very people it is supposed to help.

John J. Letizia, president of Laurel Medical Supplies, Inc. in Pennsylvania and vice chairman of AAHomecare, explained that in order to be reimbursed for repairing power wheelchairs, CMS required companies to collect the documentation of medical necessity that was originally submitted when the beneficiary was approved to receive the equipment. That becomes a problem, Letizia said, when the supplier who provided the equipment is out of business and there is no access to the paperwork.

“In many cases, CMS wants patients to go to the doctor and get the documentation from them. For patients with serious medical conditions, that can be a challenge. If your power wheelchair is broken, and you’ve lost your ability to move around, getting to the doctor to justify that you need a wheelchair that you already have can seem overwhelming. This new guidance from CMS could help prevent these situations.” said Letizia.

“We are heartened that CMS has realized that a meaningful policy change is necessary to ensure consumers can access repair services, said Cara Bachenheimer, senior vice president of government relations, Invacare. “While we still have issues with payment levels, changing the documentation requirements to a more pragmatic requirement will absolutely help consumer access.” AAHomecare Complex Rehab and Mobility Council members, AAHomecare staff and allied consumer groups have met with CMS repeatedly to discuss the documentation issues that are among the root causes of the problems with equipment repair.

AAHomecare looks forward to working collaboratively with CMS to help patients get access to the home medical equipment, services and supplies they need to receive medical care at home. The American Association for Homecare represents providers of home medical or durable medical equipment and services who serve the needs of millions of Americans who require prescribed oxygen therapy, wheelchairs, enteral feeding, and other medical equipment, services, and supplies at home. Visit aahomecare.org.