Now that the Patient Access and Medicare Protection Act (PAMPA) has gone into effect, CMS has posted instructions to Medicare providers for billing accessories used with Group 3 complex rehab power wheelchairs — and those provider might not be happy with the guidelines.
“This published billing policy violates the intent of the year-end Congressional legislation and unfairly places significant burdens on CRT providers … ,” said Donald Clayback, executive director of National Coalition for Assistive and Rehab Technology. “… This is what the year-end legislation was to prevent.”
Singed into law by President Obama in late December, the Patient Access and Medicare Protection Act requires a one-year delay in the application of competitive bid pricing to power complex rehab wheelchair accessories. The Act covers accessories (including seating systems) and seat and back cushions for Group 3 complex rehab power wheelchairs currently described by HCPCS codes K0848 through K0864.
CMS’s announcement, titled “Implementation of Section 2 of the Patient Access and Medicare Protection Act,” said the agency cannot immediately comply:
“Although this change is effective January 1, 2016, changes to the Medicare claims processing system cannot be implemented any sooner than July 1, 2016,” the statement reads. “Until these changes are implemented, payment for these items will be based on the adjusted fee schedule amounts. Suppliers can submit claims for these items with dates of service on or after January 1, 2016, but payment will be based on the adjusted fee schedule amounts. On or after July 1, 2016, suppliers can adjust previously paid claims with dates of service on or after January 1, 2016, to receive the full fee schedule amount.”
CMS added that in coming months it will provide more information, including a list of HCPCS codes for accessories affected by the announcement, and further instructions regarding the submission and processing of claims for these items.
“This published billing policy violates the intent of the year-end Congressional legislation and unfairly places significant burdens on CRT providers which will compromise their ability to provide continued access to the complex rehab wheelchairs used by people with high level disabilities,” said Donald Clayback, executive director of National Coalition for Assistive and Rehab Technology. “We are reaching out to CMS and to our Congressional champions to point out the unreasonableness of paying providers at reduced payment amounts for the next six months. This is what the year-end legislation was to prevent. It is also unreasonable to then require providers to have to ‘resubmit’ six months of claims after July 1, 2016 to get paid the proper amount.”
Clayback said NCART will supply further updates as more information comes in.
In related news, NCART will be outlining its legislative and advocacy plans to protect access to care and equipment for people with disabilities on a special call. The “CRT Legislation Update” call for CRT stakeholders is slated for Feb. 9 at 4 p.m. Eastern Time. to review our planned activities. Additional call-in details will be provided next week.