Medicare Compliance & Reimbursement

But how will suppliers fare in the Wheeler Dealer war?

Wheelchair suppliers, beneficiaries and physicians have spoken, and the Centers for Medicare & Medicaid Services has heard.

The good news: CMS will soon pull the so-called "clarification" to wheelchair coverage policy issued last December.

"CMS has decided to retract the December 9, 2003 Durable Medical Equipment Regional Carrier (DMERC) Article which was intended to reiterate our coverage policy on power wheelchairs," CMS says in a March 18 memo to congressional health staffers.

The move is a result of "concerns voiced by the power wheelchair community" in open door forums in February and March, the memo says.

The American Association for Homecare says it is "pleased" by the impending retraction and "very grateful that CMS continues its Open Door Forums and policy of responsiveness."

CMS awoke "a sleeping giant" by angering the wheelchair beneficiary community, says Erik Sokol with the Power Mobility Coalition.

CMS says it plans to issue a release regarding the retraction soon.

What Does the Retraction Mean?

But the congressional memo leaves many suppliers' questions unanswered, especially since CMS never admits there was any problem with the December policy. The article was supposed to be a policy reiteration, CMS says in the memo. "CMS will continue to pay claims as it has prior to and following the issuance of the ...  DMERC Article."

PMC hopes the retraction means CMS will revert to its coverage policy that says power wheelchairs are covered by Medicare when the beneficiary is "usually" bed- or chair-confined, says Sokol.

That interpretation would allow wheelchair coverage even if patients can take a few steps to get to the bathroom or the kitchen, if they have respiratory or neuromuscular diseases, and other relevant conditions. The DMERC article restricts coverage if patients can take more than a step or two under any circumstances, suppliers charge.

But whether CMS will use the "usually" standard "is the $64,000 question," Sokol tells MLR.

Even if the battle against the "one- or two-step fiasco" is won, there are many other problems stemming from Operation Wheeler Dealer that threaten suppliers' livelihood and beneficiaries access to equipment, Sokol maintains.