Although providers hoped to hear “April Fools,” the rule transitioning certain complex rehab items to capped-rental status went into effect Tuesday as planned.
“This change in regulation is so ridiculous, and the basis behind it is so ridiculous, that my Pollyanna personality made me believe we were really going to get a delay or have the whole thing retracted,” said Doug Westerdahl, president of Monroe Wheelchair.
Stakeholders and lawmakers called on CMS to delay implementation of the rule re-classifying 78 codes, including tilt-in-space manual wheelchairs, pediatric manual wheelchairs and manual wheelchairs with power assist, as capped-rental items.
Industry leaders will now work with the lawmakers behind their bill to create a separate benefit for complex rehab to add an amendment making all complex rehab items available as a purchase or with a purchase option.
“The complexity this adds to what I’d call a very, very delicate situation is uncalled for,” said Bruce Bayes, president and CEO of Custom Mobility. “There’s no way a provider can provide, on a rental basis, what is needed on a permanent basis.”
With the rule in effect, numerous real-life implications are starting to take shape. Should a patient be hospitalized, for example, the provider must now stop billing during the hospitalization, then resume rental when the patient is released. That means storing the items, then bringing them back out for use, Bayes said.
“We’re going to take care of our customers, but we will not be able to, in the long term, provide brand-new equipment totally customized to that individual on and off again,” Bayes said. “You physically cannot do it.”
While they wait for scenarios like these to crop up, providers are already making business decisions like limiting the choices they offer customers. Monroe Wheelchair will still provide manual tilt-in-space chairs, but only from a limited number of manufacturers, said Westerdahl.
Additionally, Monroe Wheelchair will no longer provide power-assist devices. On April 1, it cancelled three orders, said Westerdahl.
“They’re too expensive and require too much service,” he said.
Adding insult to injury: The overall billing process for these items will now end up costing more.
“The 5% additional revenues we will realize over the 13 months will not cover the additional costs we are going to incur,” said Westerdahl.