Home Health & Hospice Week

Large slashes to Medicare payment rates are suppliers' worst nightmare - and they could be right around the corner for some costly items.

Although it won't occur immediately, the Centers for Medicare & Medicaid Services still is dead set on undertaking an inherent reasonableness review of power wheelchair reimbursement, CMS Administrator Tom Scully confirmed in a Nov. 5 Open Door Forum for home health.

With its IR authority, CMS could slash reimbursement rates for wheelchairs 15 percent per year, spreading larger cuts over multiple years.

CMS is gathering data now for the review, although any resulting adjustments will not be "imminent," a CMS staffer said in the forum. While it may not be an "apples-to-apples" comparison, CMS plans to look at wheelchair payment rates for the Veterans Administration for the IR review, Scully said. Other sources of comparative data will include "big purchasers," even including different countries, he said.

If the IR review finds the Medicare rates to be reasonable, rates won't change, Scully emphasized. "We should pay the right amount," he said in the forum. CMS wants to make its "appropriate" partners happy and give them a decent return on investment for providing seniors with wheelchairs, he added.

The review is part of Operation Wheeler Dealer, the feds' fraud-fighting campaign regarding power wheelchairs and scooters.

The agency still must issue its official guidelines on the IR process to its contractors. CMS published the IR interim final rule last December (see Eli's HCW, Vol. XI, No. 45, p. 362).