Wheelchair Cushion Victory for HME
The implementation of competitive bidding for durable medical equipment by Medicare produced countless challenges for the complex rehab industry to face in ensuring beneficiaries’ access to quality medical equipment and services.
The first of these challenges was Medicare’s decision in 2007 to competitively bid complex power wheelchairs. The industry met this challenge and overcame it when Congress passed legislation in July of 2008 specifically excluding complex power wheelchairs from competitive bidding.
While this was a major success, it was only the first of many battles. Most recently the battle has shifted to manual wheelchairs and accessories used for complex rehab situations. In the fall of 2011, Medicare announced that it would be launching competitive bidding in 91 of the largest U.S. metropolitan areas, including New York, Chicago and Los Angeles. Further, Medicare announced its intention to competitively bid all manual wheelchairs and items that they deemed to be accessories for those wheelchairs. This created several new challenges associated with specific types of chairs, more complex accessories and items that were assigned to underdefined Medicare codes.
One such group of products was adjustable skin protection seat cushions. These products require significantly more assessment and set-up service. In addition, adjustable skin protection cushions were assigned to underdefined codes that included a myriad of products of varying sizes, shapes, materials, durability, functionality and performance. We were concerned that the bidding of these products under their existing coding structure would create a rush to the bottom and would produce a situation where beneficiaries’ access to the specific goods they needed would be reduced, if not eliminated.
Amid a major crisis within the funding system for wheelchair cushions, we saw an opportunity to make substantial changes to the way adjustable skin protection cushions were classified, so that the codes could represent more clinically homogenous groups of products. We argued that the codes for these products needed to be fixed before competitive bidding began, or excluded.
I am very pleased to say that our combined efforts produced results. On Dec. 27, 2011, the Centers for Medicare & Medicaid (CMS) announced the exclusion of the four adjustable skin protection cushion codes—E2622, E2623, E2624 and E2625—from the upcoming round of competitive bidding.