Wheelchair Accessories Used on Group 3 Power Wheelchairs Will Pay INCORRECTLY

Posted on in Billing/Reimbursement

We are very sorry to report that CMS has officially announced that the implementation of Section 2 of the Patient Access and Medical Protection Act (PAMPA), which exempted accessories used on group 3 power wheelchairs from the adjusted fee schedule amount-based competitive bid pricing, will not occur until July 1, 2016. This means that accessories used on group 3 power wheelchairs will pay at a lower rate than what it should (fee schedule). The Act that included exempting accessories used on group 3 bases was passed on December 28, 2015, and was effective January 1, 2016.

Many providers have been holding claims with the hope that CMS would announce the system would be updated to pay these accessories accurately shortly after January 1 (the effective date). However, with this delayed implementation, it would be best to send the entire claim in and request a reopening adjustment for those accessories that paid incorrectly (competitive bid rate).

We realize this is a tremendous burden on the provider in having to track these incorrect payments and request a reopening at a later date due to the resources required to manage this. We will continue to work with legislators and CMS to stress the importance of having this implemented in a more timely manner. We will keep you posted.  

NCART Release: CMS Issues Unreasonable Billing Instructions

If you have any questions, please contact Dan Fedor at [email protected] or 844-794-8459.