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Medicare Mobility Scooter Requirements (What a Mess)

The power wheel chair industry has raised its voiced in complaint against the Centers for Medicare and Medicaid Services (CMS). According to the suppliers, CMS might be violating the Paperwork Reduction Act pertaining to CMS' documentary requirements as per its Final Rule in acquiring power wheel chair benefits of Medicare. The Paperwork Reduction Act is a law that limits the amount of paperwork or documentation the government can impose through its regulations on any industry. The United States Congress recently joined the fray on the suppliers' side.

The conflict stems from Medicare power wheel chair benefits changes from two years ago. According to the suppliers, the documentation requirements imposed by CMS are vague at best. They also perceive a subtle attempt to transfer some documentary requirements to physicians. Suppliers accuse CMS of creating a system that delays the benefit of the end user instead of creating one that will harmonize the suppliers, physicians and beneficiaries.

Before the changes were made, suppliers claim that CMS rejected $100 million worth of claims from beneficiaries. According to the suppliers, the reviews that lead to the rejections were subjective and inconsistent. Adding to the supplier's woes, a sharp decline in power wheel chair sales coincided with the implementation of the new regulations last fall. This decline in sales led the suppliers to believe that several aspects of CMS' new documentary requirements are detrimental instead of beneficial to the power wheel chair industry, the physicians and the beneficiaries.

According to the Restore Access to Mobility Partnership (RAMP), the calculations used by CMS to satisfy the paperwork requirements "are not based in the practical realities that suppliers and physicians face when obtaining power wheelchairs for patients". Furthermore, that CMS is again burdened by their erroneous perception of the Medicare power wheel chair benefit, which happens to be vastly different from the reality of how it actually works.

"The practical experience of hundreds of supplier locations and additional anecdotal evidence indicates that the burden is much greater", says RAMP. "Further, creating a 'combined' estimate of the burden to suppliers and physicians additionally undermines the credibility of the numbers put forward by CMS in the Rule. Finally, the underlying assumptions made by CMS ... are either incorrect or are simply not supported by actual or sufficient evidence to be useful or credible."

According to RAMP, they have no trouble with CMS requiring physicians to provide medical documents to suppliers, as this step is necessary for suppliers to determine the needed equipment and for CMS to review the claim. "However, the CMS claim that the Rule shifts the burden of collection to physicians is not accurate or justified," RAMP wrote. "The 'extensive education campaign' relied on by CMS regarding a change in physician attitude and behavior has not taken place, nor have the changes alluded to."

According to Mike Pfister, president of The SCOOTER Store, the vague guidelines on documentation will force suppliers to collect medical documentation by the dozen to support payment of claims. "There has to be a resolution that will allow all qualified Medicare beneficiaries to use the power wheelchair benefit," he said. "The new rule puts up too many hurdles that will delay, and in some cases, prevent suppliers and physicians from meeting the mobility needs of beneficiaries, particularly senior citizens."

Rep. Candice Miller (R) of Michigan, chairperson of the House Government Reform Subcommittee on Regulatory Affairs, advised CMS that she is "greatly concerned" that the Final Rule fails to properly evaluate the new burden on suppliers. Contrary to claims made by CMS that the burden of paperwork is no greater than before, Rep. Miller stated that, "the reality that suppliers now must collect both the prescription and additional documentation on all of its claims is not the same burden as the former requirement ... "

"Medicare regulations should be designed with an eye towards clarity, fairness, and objectivity," wrote Rep. Henry Cuellar (D) of Texas. "Unfortunately, the collections of information in the new CMS rule are unwieldy, ambiguous, and highly subjective. Under the new rule, Medicare suppliers must collect and review all medical records that CMS reviewers may later determine are necessary to verify a detailed written prescription from a treating physician. If a supplier fails to collect certain records that a reviewer later determines are needed, or if a claims reviewer disagrees with the medical judgments made by a treating physician, the supplier risks substantial economic harm."




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