Stakeholders: ‘We Want To Fix This Issue For Good'

Published in Complex Rehab on March 20, 2023

RepairsThis article was originally featured in HME News.

Complex rehab stakeholders, including NCART, AAHomecare, U.S. Rehab and state and regional associations, are working on a more comprehensive strategy for service and repair reform. 

While they hadn’t finalized that strategy at press time in early February, stakeholders say the main areas that need to be addressed are increased reimbursement for service and repairs, decreased administrative burdens and improved communication with consumers. 

“We want to fix this issue for good,” said Wayne Grau, executive director of NCART. 

A major reason for the reform: A growing number of right-to-repair bills that allow consumers to buy parts directly from manufacturers and repair their own equipment. Bills have been passed in Colorado and New York and have been introduced in 16 other states. 

Increase Reimbursement 

While providers are seeing a 6.4% or 9.1% reimbursement increase for Medicare in 2023, depending on their location, that’s not enough to cover their increased costs for service and repairs, stakeholders say. 

"The provider doesn’t make money – most of the time, they’re losing money – on repairs,” said Dan Fedor, director of reimbursement and education for U.S. Rehab, a division of VGM & Associates. “The reimbursement rates for what they’re doing isn’t adequate at all, even with the increases in 2023. It helps, but it’s not enough to cover the increases in cost of goods and staffing and fuel and overhead.” 

What’s more, Medicare is only a portion of any provider’s payer mix, with the increase not guaranteed for other payers like private insurance and Medicaid, stakeholders say. 

Decrease Burdens 

Private insurance and Medicaid can also be a challenge because, unlike Medicare, they often require prior authorizations and other administrative burdens that significantly slow down service and repairs, stakeholders say. A backlog due to the COVID-19 pandemic has compounded the issue, they say. 

“What happened when COVID hit was, all of our CRT providers saw more requests for repairs,” Grau said. “This is at the same time they’re being burdened with labor shortages and the supply chain affecting their ability to get parts. It was a huge backlog, and we still have issues with labor shortages and supply chain.” 

Stakeholders are making headway in some states like Massachusetts, where the Medicaid program has decided not to require prior authorizations for repairs under $2,000, stakeholders say, but it’s a state-by-state and payer-by-payer battle. 

Improve Communication 

Stakeholders want to improve communication between providers and consumers to better reflect the current environment, they say. 

“There can be this belief that the reason the chair isn’t being fixed is our fault,” said Gerry Dickerson, who sits on the Executive Committee of NRRTS. “We can fix any chair, taking into consideration the quirks around parts and how they’ve always been a problem and now you have supply chain issues. We can fix it if we have the part, but we can’t fix it without your insurance company’s prior authorization.”


TAGS

  1. complex rehab
  2. repairs

From Our Experts

Registration Opens for Heartland 2024 thumbnail Registration Opens for Heartland 2024 Registration for VGM's annual Heartland Conference is now open. This popular event will be held June 10-12, 2024, in Waterloo, IA. Welcome to 2024. Let's Talk Root Causes! thumbnail Welcome to 2024. Let's Talk Root Causes! Kim Cuce explains how to identify the root causes of issues that DMEPOS providers often face. Meet Direct Supply® – Bringing Innovation to the HME Industry thumbnail Meet Direct Supply® – Bringing Innovation to the HME Industry In today's episode, Dave Lyman, Senior Vice President of Sales for VGM & Associates talks with our vendor partner, Direct Supply. Dave and Nick Bush, Director of Business Development for Direct Supply, discuss supply chain reliability, creating outrageous customer service, and the importance of innovation and technology. New Partnership Between MK Battery and Rolko thumbnail New Partnership Between MK Battery and Rolko In today's episode of Industry Matters, U.S. Rehab edition, Tyler Mahncke of U.S. Rehab discusses a new partnership between MK Battery and Rolko. By formulating this new partnership, U.S. Rehab members will now be able to order wheelchair parts through MK Battery, which is a cost and time savings for complex rehab providers. Heartland Education Sessions and Prospectus Unveiled for 2024 thumbnail Heartland Education Sessions and Prospectus Unveiled for 2024 The VGM Heartland Conference is back, and this year will have a large focus on the CRT industry, with more CRT-dedicated courses, industry expert speakers, and vendor partners than ever before. Business Forecasting: Strategies, Types, and Key Insights for 2024 thumbnail Business Forecasting: Strategies, Types, and Key Insights for 2024 In our current environment, with the challenges we face in billing, staffing and product availability, and ultimately the sustainability of our businesses, forecasting can be a great tool to help us manage those challenges. VGM and U.S. Rehab Announce Billing & Reimbursement Seminars in 2024 thumbnail VGM and U.S. Rehab Announce Billing & Reimbursement Seminars in 2024 VGM and U.S. Rehab are pleased to announce a series of in-person billing and reimbursement seminars for 2024, titled “Forensic Denials DME 2024 – Season 3: Episode 1.” Wound Care 101: A Guide for DMEPOS Providers thumbnail Wound Care 101: A Guide for DMEPOS Providers VGM Wound Care presents a comprehensive program designed to assist members in effectively offering wound care products and services, meeting patient needs, and concurrently expanding their business revenue streams.