In early December, the durable medical equipment regional carriers posted Web bulletins clarifying existing Medicare coverage policy for motorized wheelchairs and power-operated vehicles (POVs). Part of the Centers for Medicare and Medicare Services' Operation Wheeler Dealer initiative, the so-called clarifications actually provide a more restrictive definition of the circumstances under which Medicare will provide coverage for a motorized wheelchair.
The bulletins state that these medical review guidelines will be applied not only to new reviews but also to any provider-specific reviews the DMERCs are currently conducting. The attempt to apply these medical review guidelines retroactively is unfair and contrary to Medicare law and regulation.
While the industry must fully support CMS and DMERC activities to eliminate fraud from Medicare, these policy changes will have absolutely no impact on fraudulent firms' behavior. Instead, these policy changes will simply prevent many needy beneficiaries from being able to get around inside their homes.
We must engage consumers and disabled communities to speak out.
Get Involved
What can you do on a local level?
First, contact your local seniors and disease groups, such as the Grey Panthers, AARP, Multiple Sclerosis Society, Arthritis Foundation, Muscular Dystrophy Association, Spina Bifida Association and the United Cerebral Palsy Association. Also contact your local rehabilitation hospital and its rehab and physical therapists.
Educate these groups about the Medicare policy change. Provide a copy of the DMERC bulletins and explain your feelings about the recent clarification. Ask these groups, along with individual clinicians, to write a letter to their members of Congress.
What should the letters say? Use the following points as a guide. Remember, individualized letters will have the most impact.
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The DMERC bulletins provide a very restrictive definition of the term “nonambulatory” for purposes of Medicare coverage.
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Specific information is now required to be documented in the patient's medical record as to the distance that the patient can walk independently and with the assistance of a walker or other ambulatory aid.
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This information must be documented in the patient's medical record prior to delivery.
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The patient's medical record consists of evaluations, notes and other information created by non-supplier individuals. Notes or documentation prepared by an occupational or physical therapist employed or paid by the supplier or other supplier employees will be given only limited consideration and must be corroborated in the patient's medical record.
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These requirements will be applied to both new claims and retroactively to those claims previously submitted.
Engaging beneficiaries — those personally affected by this clarification — will significantly increase our chances that the administration and CMS will rescind this Medicare coverage restriction and enable continued access to those who truly need mobility devices within their homes.
In addition, the documentation must describe strength and function of the upper and lower extremities (including tone, range of motion limitations, etc.). This applies to all power wheelchairs and POVs.
A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at cbachenheimer@invacare.com.
