Underpayments to CRT Accessories Remain a Top Concern for U.S. Rehab

Posted on in Billing/Reimbursement, HME Government Issues

By: Kayla Mahler, U.S. Rehab

Last December ended with good news of a delay to the application of competitive bid rates to complex rehab power wheelchair accessories used on Group 3 power wheelchairs. However, the celebration ended early as the Centers for Medicare and Medicaid Services (CMS) did not include wheelchair accessories used on Group 2 complex bases nor complex manual chairs (K5, E1161) in the delay. CMS also announced that changes to the Medicare claims processing system cannot be implemented until July 1 (the next regularly scheduled update), meaning that all accessories on Group 3 power chairs would be paid at the competitive bid adjusted rate (underpaid from Jan. 1 – June 30). 

“The inability for CMS to administer the payment rates mandated by Congress is a significant failure of our government that has implications at multiple levels,” said Greg Packer, president of U.S. Rehab. This could have been implemented much sooner than July if CMS would have prioritized it as a system update for March.

What seems to us to be a simple fix to the Medicare’s system actually puts a huge responsibility on the provider to keep track of the underpayments and request they be paid accurately July 5. If you aren’t keeping track of these underpayments, you may be leaving money on the table. In April, Dan Fedor outlined this issue and how it should be tracked so a reopening can be requested. For more information, please participate in Dan’s webinar, “EVERY Penning Counts,” on May 18 at 10 a.m. CDT.

A work group of industry leaders met in early February to discuss 2016 legislative priorities. The meeting, which included teams from VGM, U.S. Rehab and NCART, highlighted the complex rehabilitation technology (CRT) accessory issue and the importance of monitoring the financial burden per claim placed on providers. The work group determined that an additional delay to competitive bidding reimbursement cuts was not an option. Instead, they would lean on full finalization of a plan that avoids reimbursement cuts.

The CRT industry made advances in Congress last year, and several bills were introduced to help protect CRT. H.R.3229 and S.2197 were introduced to provide a technical correction to clarify that CMS cannot apply Medicare competitive bid pricing to accessories used with complex rehab wheelchairs. VGM and U.S. Rehab continue to actively ask for additional co-sponsors to these bills. Currently, there are 95 House and 17 Senate co-sponsors.

The CRT industry also has H.R.1516 and S.1013, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015, active with 162 House and 14 Senate co-sponsors. We continue to promote all of these bills and still advocate for additional co-sponsors.

The industry has learned that it is important to clarify the distinction between standard equipment and complex rehab technology. Many legislators and their health legislative assistants (LAs) do not understand both that distinction and why CRT should be paid at a higher rate.

On April 21, NCART hosted a CRT Expo on Capitol Hill. More than 40 members of Congress and their staff attended, learned about CRT and saw the difference between standard equipment and CRT. Tom Powers of VGM Government Relations and Dan Fedor of U.S. Rehab attended to help explain why patients would need CRT and ask for their support of the CRT bills.

“The CRT Expo was very well received,” said Powers. “It was a great learning experience and learning environment for legislative staff. Thank you to those who invited their representatives to attend.”

Powers and Fedor also had several meetings with legislators and health legislative assistants that day.

“Tom and I met with six congressional offices and explained how the cuts to reimbursement are affecting our members,” said Fedor. “Members have absorbed these cuts over the past several years but can no longer afford to take the brunt of the Medicare cuts and will have no choice but to pass this along to the beneficiaries.”

Our industry needs additional co-sponsors to these bills. Our aim is to have legislation passed by the end of this congressional term. Please continue to reach out to your representatives from your districts. Tell your story, and explain why CRT is medically necessary for certain patients and what cuts to reimbursement would do to your business and your ability to provide care to patients. While they are out on break, arrange to have a meeting with them face-to-face. Contact VGM Government Relations if you need any help. 

“Where the rural rollout of competitive bid rates affects all VGM and U.S. Rehab members alike,” said Packer, “these cuts to reimbursement rates to CRT accessories are detrimental. We must have a permanent legislative fix to exclude CRT accessories from competitive bid rates. If reimbursement decreases, providers will no longer have the resources to provide quality equipment to the neediest population.”