Home Health & Hospice Week

Changing tilting wheelchairs from a capped rental to routinely purchased category might not be as painful as it first appeared.

Durable medical equipment suppliers who have submitted claims under the capped rental category for E1161 (manual wheelchair, includes tilt in space) can submit claims under the routinely purchased category when the Centers for Medicare & Medicaid Services switches the item's category in July, says DME regional carrier Cigna.

"All rental payments made previously will be applied against the purchase allowance," Cigna explains in response to a question posed by the Region D DMERC Advisory Committee.

While that sounds promising, Peggy Walker, a billing and reimbursement advisor for Waterloo, IA-based rehab network U.S. Rehab, wonders how the DMERCs will accomplish the feat under claims processing system restraints.

"How will they do it? What's the process?" Walker wants to know. Suppliers need specific instructions from DMERCs before they can breathe a sigh of relief on this issue, she insists.

But consultant Lisa Thomas-Payne has confidence the carriers can pull it off. "The way the DMERC is handling the application of any rentals toward a purchase is the way Medicare has always handled it, ever since [capped rentals] went into effect in the late 80s," says Thomas-Payne, with Medical Reimbursement Systems in Albuquerque, NM.

Thomas-Payne expects there will be few rentals out there for the DMERCs to convert to purchase in any case.

In further good news, suppliers won't have to obtain a new certificate of medical necessity for the item when making the switch either, says Cigna, the DMERC for 17 states.

The same advice goes for pediatric wheelchairs, codes E1231 through E1238, points out Cigna. The DMERC will post the guidance on its Web site as a frequently asked question in the next few days, Cigna medical director Robert Hoover tells Eli.

CMS is changing the items' categories after it found out they were more often purchased than rented (see Eli's HCW, Vol. XII, No. 18, Article - Coding).