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Wheelchair Accessories used on Group 3 Power Wheelchairs will pay INCORRECTLY from Jan 1 – June 30, 2016

US Rehab logoWe 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