We are very sorry to report that CMS has officially announced that the implementation of Section 2 of the PAMPA, which exempted accessories used on group 3 power wheelchairs from the adjusted fee schedule amount based competitive bid pricing, will not be implemented until July 1, 2016. This means that accessories used on group 3 power wheelchairs will pay at a lower rate than what it should (fee schedule). The Act that included exempting accessories used on group 3 bases was passed on Dec. 28, 2015 and was effective Jan. 1, 2016.
Many providers have been holding claims in the hope that CMS would announce the system would be updated to pay these accessories accurately shortly after Jan. 1 (the effective date), however, with this delayed implementation it would be best to send the entire claim in and request a reopening adjustment for those accessories that paid incorrectly (competitive bid rate).
We realize this is a tremendous burden on the provider in having to track these incorrect payments and request a reopening at a later date due to the resources required to administer the adjustment. We will continue to work with legislators and CMS to stress the importance of having this implemented in a timelier manner. We will keep you posted.
NCART Release: CMS Issues Unreasonable Billing Instructions
Just a few seconds of your time can make a difference to people who use complex wheelchair accessories. If the petition receives over 100,000 signatures in the next month, it will head to the desk of Pres. Obama. Please take the time today to sign the White House petition. Ask your friends and family to sign the petition and share on social media.
The bill language is the same as last year’s CRT legislation with one important addition. H.R. 1516 includes a new provision that will allow all CRT codes to be billable as a “purchase” rather than subject to “capped rental” treatment. This recognizes the individualized nature of CRT items and that they are supplied to meet permanent, not short-term, needs.
At the time of re-introduction Congressman Sensenbrenner stated: “As a leader in the fight for the rights of the disabled, I want to ensure all Americans have access to the tools needed to live each day to the fullest. Americans with disabilities should not be denied rehabilitation or medical equipment that can enable them to live and work freely and independently. With increased flexibility and proper oversight, we can help those in need while inhibiting fraud and abuse.”
Congressman Crowley added his comments: “Complex rehabilitation technology products can make a world of difference for people with severe disabilities and other medical conditions, and our legislation will remove barriers to getting these wheelchairs and other services to those who need them to lead a more independent life. I look forward to advancing this legislation that recognizes the importance of maintaining access to these products, as well as puts in place much-needed quality standards and consumer protections that strengthen the Medicare program for individuals, clinicians and suppliers.”
We are expecting the re-introduction of the companion bill by Senators Thad Cochran (R-MS) and Chuck Schumer (D-NY) in the near future.
Also, Muscular Dystrophy Association has officially pledged their support for the CRT legislation.
We hope you will reach out to your members of Congress seeking support of these bills.