Home Health & Hospice Week

Stakeholders call for revisions.

The feds' effort to "ensure accurate Medicare reimbursement" for power mobility devices is off to a misguided start, says industry representatives.

Background: In June, the Centers for Medicare & Medicaid Services released long awaited new Healthcare Common Procedural Coding System (HCPCS) codes for power mobility devices (PMDs). Aiming for an Oct. 1 implementation of the new codes, CMS then released draft information regarding pricing for the various new codes on Aug. 10. The agency's brief comment period ended Aug. 25.

Big problem number 1: CMS has proposed supplementing manufacturer suggested retail prices (MSRP) with the retail prices culled randomly from the internet.

"The use of internet merchants pricing data in developing fee schedules for the new codes will result in inaccurate Medicare payment for these products and create what may be insurmountable barriers to access for beneficiaries," charges the American Association for Homecare in an Aug. 25 letter to CMS.

Medicare-enrolled suppliers can't afford to compete with the discounted prices of internet retailers, charges Eric Sokol of the Power Mobility Coalition in Washington, DC, citing fundamentally incompatible business models.

That equals potential problems in access for beneficiaries, warns Sokol.

Big problem number 2: Power mobility device manufacturers and their representatives also report that a list released by the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) just prior to CMS' pricing guidance misclassifies many or even most of their products. Manufacturers including Invacare of Elyria, OH, and Exeter, PA-based Pride Mobility Products have called CMS' attention to the pricing discrepancies.

Fee schedules for the new HCPCS codes are expected to be published as part of the October durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) update.

Stay tuned: After the publication of the fee schedule, the DME Program Safeguard Con-tractors will develop an article that will provide additional information on this subject, reports Palmetto GBA.