Expect Wheelchair Downcodes Once Scooter Regulations Are Finalized A rule making it easier to order scooters could make it harder for suppliers to secure power wheelchair payments. Current regulations have different requirements for who can order wheelchairs versus scooters, notes a Centers for Medicare & Medicaid Services representative. Aforthcoming regulation included in CMS' Semiannual Regulatory Agenda "will simplify that," the rep tells MLR. The change will allow all physicians, instead of just specialists, to order scooters. It is part of CMS'10-point plan for Operation Wheeler Dealer. Attorney Timothy Webster expects to see a rash of power wheelchair downcodes once the regulation takes effect. The durable medical equipment regional carriers will likely downcode K0011 wheelchairs to less expensive scooters, predicts Webster, of Amarillo, TX-based Brown & Fortunato. Medicare "will pay scooter prices for wheelchairs," Webster forecasts. The new rule will make it easier to deny pricier wheelchair claims. But just how easy that may be remains to be seen. It depends on how the regulation is written, says attorney Cara Bachenheimer, vice president of government relations for Invacare Corp. in Alexandria, VA. Industry observers are surprised CMS has delayed this regulation, since it was part of the agency's highly touted crackdown on power wheelchair fraud. CMS originally slated the reg for release last February. Other DME items in the agenda include:
It's common for items on the regulatory agenda to be pushed back, and Webster wouldn't be surprised for the bidding proposed rule to be one of them. Bidding will be "a tremendously complicated system," he predicts. CMS notes it must issue the proposed and final rules at least six months prior to the Jan. 1, 2007 implementation date for the new payment system. Editor's Note: The agenda is at www.access.gpo.gov/su_docs/fedreg/a040628c.html under Health and Human Services Department.
"It's not real complicated," Webster notes, so the reason for the delay isn't evident.
"This reg is going through the clearance process, which means it could come out next week or in October," Bachenheimer points out. CMS sets a September deadline for the interim final rule.