Issue link: https://read.dmtmag.com/i/50323
■ Don Clayback says CRT shouldn't be included in the PMD demo project because there are already safeguards in place. See story this page. Republican co-sponsor needed for CRT bill. . . . . . . . . . . 21 Stakeholders react to demo ........................ 21 MK Battery donations recharge advocacy ............ 21 Hoveround moves beyond commercials. . . . . . . . . . . . . . 22 Mobility WWW.HMENEWS.COM / JANUARY 2012 / HME NEWS 21 BRIEFS CMS drops rehab codes from NCB Round 2 WASHINGTON – CMS announced Nov. 30 that it has removed ultra lightweight man- ual wheelchairs, gimbaled ventilator trays and push activated power assist devices from the standard wheelchair product cat- egory for Round 2 of competitive bidding. Industry stakeholders had worked to have these codes dropped from competitive bidding since the product categories were announced in August. However, in a bul- letin to members, Peggy Walker, a billing and reimbursement adviser for The VGM Group's U.S. Rehab, stated the exclusion is temporary and that the codes (K0005, E0986 and E1030) are expected to be part of future rounds of the program. Specialty skin protection and positioning adjustable wheelchair cushions (E2622-E2625) will still be put out to bid. K0823 review shows documentation issues WASHINGTON – A prepay review of K0823 power wheelchairs by National Govern- ment Services, the Jurisdiction B DME MAC, denied 121 of 163 claims, for a 74% claim error rate. The most common issues leading to these denials included a lack of medical records or the records did not es- tablish medical necessity; lack of sufficient evidence of a physician face-to-face mo- bility exam; or the seven-element order or detailed product description was invalid or incomplete. Lawmaker supports separate bid category WASHINGTON – Sen. Robert Casey, D-Pa., on Nov. 9 sent a letter to Laurence Wil- son, director of CMS's Chronic Care Policy Group, urging the agency to create a sepa- rate category for manual wheelchairs under competitive bidding. While industry and consumer groups have weighed in on the issue, this is the first such letter from a law- maker, stakeholders say. United Seating & Mobility acquires Rehab Specialist RALEIGH, N.C. – United Seating and Mobil- ity (USM) announced Nov. 17 that it will acquire The Rehab Specialist's complex mobility business. USM/TRS will continue to provide services in the Raleigh-Durham, N.C., area. USM President and CEO Bob Gouy stated in a release that the addition strengthens USM's position in what he called "a growth market." RESNA seeks nominees ARLINGTON, Va. – It's time to spotlight indi- viduals who have made significant contribu- tions to assistive technology, rehabilitation engineering, or RESNA. RESNA members have until Feb. 14 to nominate an individual or organization for awards in seven catego- ries. More information is available at www. resna.org. Wanted: GOP support for complex rehab BY ELIZABETH DEPREY, Associate Editor WASHINGTON – The search is on for a Republican co-sponsor for a bill to create a separate benefit for complex rehab technology (CRT), NCART Executive Direc- tor Don Clayback told listeners during a Nov. 28 conference call. "Our objective right now is to secure bipartisan introduction of the bill," said Clayback. "We're looking for a Republican in the most influential position we can obtain." In late October, the steering committee working on the bill, led by Clayback, secured a guar- antee from Rep. Joseph Crow- ley, D-N.Y., to sponsor it. Once the bill is introduced, the work to secure additional cosponsors will begin, along with efforts to find a legislative vehicle. Progress has been slower than stakeholders expected, Clayback said, due to Congress' focus on reducing the deficit. "I think it's more challenging than it was when we first started our initiative, but that doesn't take away the need for what we're trying to accomplish," said Clayback. "I'm confident it doesn't take away our determina- tion, either." One potential obstacle: The bill would cost money because it would make adjustments to CRT payments to allow for CPI increases, and it would exempt CRT from competitive bidding. "You can't improve and protect access without making changes to the system," said Clayback. "The question is whether those changes are rational and have broad-based support." HME PMD DEMO Providers have mixed feelings BY ELIZABETH DEPREY, Associate Editor W HEELCHAIR PROVIDERS might be in favor of the prior authorization phase of the new PMD demo— if they survive the prepay phase. One major concern for providers is the potential cash flow problems created by the prepay review phase of the demo. "It's going to be a tough one," said Tim Pappert, manager of Spring Hill, Fla.-based Mrs. Mobility. "We can't wait three to six months to be paid for everything. It could potentially put us under." CMS's PMD demonstration proj- ect calls for three to nine months of prepay reviews for PMDs in seven states, followed by a prior authori- zation process for the rest of a three- year period. John Letizia, owner of Laurel Medical Supplies in Ebens- put us under." Tim Pappert, Mrs. Mobility burg, Pa., and chair of AAHomecare's Complex Rehab and Mobility Council, says Pappert is not alone. "I don't know how any provider, small or large, can do prepay review for all PMDs," said Letizia. Survival will be even more challenging for providers in the seven demo states since it comes on top of other recent changes like the elimination of the first-month purchase option, he said. "We've been trying to still provide quality products and services," said Letizia, "but people are just going to say, 'I can't do it anymore.'" The second phase of the demo calls for doctors to sub- mit prior authorization requests so providers will have some assurance of payment. That idea is more palatable, provid- ers say. "I think it's a terrific idea," said Randy Freeman, owner PROVIDERS SEE PAGE 22 NCART EXECUTIVE DIRECTOR Don Clayback, center, and NRRTS president Michele Gunn, second from left, each accepted $25,000 on behalf of their organizations at the Power for Funding event. Industry donations recharge advocacy BY ELIZABETH DEPREY, Associate Editor ATLANTA, Ga. – Although the money isn't yet earmarked for anything, NRRTS and NCART say that recent $25,000 dona- tions will be put to good use. The money was raised through MK Battery's Power For Funding initiative, now in its second year. This year, the manufacturer added a fundrais- ing reception at Medtrade. The event raised more than $70,000. That's welcome news to the event's beneficiaries. "We can use all the finan- cial support we can get," said NCART Executive Director Don Clayback. The two groups were benefi- ciaries of last year's Power for Funding initiative as well. Clayback said NCART used the money last year to aid two of its major objectives. "It wasn't targeted for any specific activity, but with the additional dollars, it enables us to be a little more active in the Medicaid arena and supports FUNDING SEE PAGE 23 Stakeholders: CMS should've worked with rehab industry 'You're taking on something significant without getting appropriate input at the front end' BY E. DEPREY, Associate Editor WASHINGTON – Stakeholders are scratching their heads over why complex power wheel- chairs are included in the new PMD demonstration project. "Our position has always been that there really hasn't been a problem in that area," said NCART Execu- tive Director Don Clayback. "It's really a small percentage of power wheelchair claims and it already has additional safeguards." Complex rehab codes in the demo include all Group 2 complex power wheelchairs and Group 3 power wheel- chairs without power options. These products already have protocols in place that would prevent fraud, Clayback said, such as specialty evaluations done by OTs and PTs, making the hardships created by the demo pointless. The prior authorization phase of the demo, however, is not as much of a cause for concern, since many Med- icaid programs already have COMPLEX SEE PAGE 23 "It could potentially