Home Health & Hospice Week

SNF bundling for DME explained in Open Door Forum.

New proposals for Medicare policies on power wheelchair coding and payment should be in your hands in just a few short weeks.

The Centers for Medicare & Medicaid Services will hold a Sept. 1 public meeting to discuss the forthcoming policies, it says in a July 23 Federal Register notice. And the meeting notice indicates the proposals at issue will be out a few weeks beforehand so participants can formulate comments, Seth Johnson, director of government relations for Exeter, PA-based Pride Mobility Corp., noted in the July 23 Open Door Forum on home health.

CMS offered no further details on the upcoming policies, but the coding proposal is expected to break up the K0011 power wheelchair code into more categories for more accurate pricing. Additional details about the meeting and policy will be posted on the Healthcare Common Procedure Coding System (HCPCS) Web site at http://cms.hhs.gov/medicare/hcpcs/default.asp, CMS said in the Federal Register notice.

The public is welcome to attend the meeting and comment on the "preliminary coding and pricing recommendations" either orally or in writing, CMS explains in the notice. Comments "will be limited to discussions of the proposed recommendations presented at the meeting on coding and payment of power wheelchairs," CMS warns. This is likely a nod to the fact that previous special open door forums for wheelchairs have ranged far off-topic when callers had little understanding of how the Medicare payment system operates.

The meeting will take place at CMS headquarters in Baltimore from 1 p.m. to 5 p.m. Details, including required registration procedures, are in the notice at www.access.gpo.gov/su_docs/fedreg/a040723c.html. Interested parties must register by Aug. 20.

The interagency work group on wheelchair coverage is staying on track and held its first meeting in the last week of June, CMS said in the forum. The work group will have three more closed meetings before the Sept. 1 public forum, and it expects to stick to its timeline announced in June, with final wheelchair policies out by year's end.

Look to SNF for DME Payments

Switching gears from wheelchair decisions, CMS also addressed skilled nursing facility consolidated billing in the Open Door Forum.

It may rankle suppliers, but for patients in a covered Part A stay, they must obtain Medicare reimbursement for durable medical equipment and most prosthetics and orthotics from the SNF, CMS explained. The only exception is a small group of high-end orthotics specifically exempted from SNF bundling by Congress.

A caller protested that pricey items such as advanced wound care products should be exempt since they aren't usual and customary. But all DME is bundled into the SNF PPS payment, not just usual and customary items, CMS responded.

Once the patient's Part A Medicare stay has expired or if she never qualifies for one, suppliers can seek separate payment for orthotics and prosthetics from Medicare Part B, CMS detailed.

However, DME is required to be furnished in the home, and the SNF can never be considered the home for DME payment purposes. So, separate payment for DME items under Part B isn't available like it is for orthotics and prosthetics, CMS said in the forum that drew more than 260 attendees.