Some Medicare Advantage Plans NOT Honoring First Month Purchase Option for Complex Rehab Chairs

Posted on in Billing/Reimbursement

By Dan Fedor, VGM Reimbursement Specialist

There has been an ongoing issue with some Medicare Advantage plans that is significantly impacting complex rehab providers. As many beneficiaries migrate to Advantage plans, many providers are accepting agreements to service those patients.

These plans state that they follow Medicare guidelines; therefore, providers accept the plan with the understanding that for complex rehab power chairs (K0835-K0864) there is a first month purchase option just as there is with Medicare fee-for-service. Unfortunately, providers are being informed that Medicare Advantage plans will only reimburse these items as a rental for 13 months.

I think these Advantage plans are misunderstanding that while these items are in the capped rental payment category and are only listed on the fee schedule as a rental fee, the Medicare beneficiary has the option to purchase complex rehab power chairs in the first month. The first month purchase option was eliminated in 2011 for standard power chairs; however, it was not eliminated for complex rehab power chairs.

VGM has made a good connection with the CMS plan administrator for Advantage Plans and they have asked for examples of when Advantage Plans have denied the first month purchase option for complex rehab power wheelchairs due to them being rental items only.

If you have any examples of this in writing, please send to me at
[email protected] or fax to 844-307-5729.