Coming Price Cuts To Certain DME

Coming Price Cuts To Certain DME

The Centers for Medicare & Medicaid Services has a medical billing change coming that will cut the reimbursement rate of power wheelchairs. Soon the Centers for Medicare & Medicaid Services will use the gap-filling method to set the medical billing fee schedule for these chairs. This new medical billing method will severely decrease the reimbursement amount for power wheelchairs.

The gap-filling medical billing fee schedule method is when the Centers for Medicare & Medicaid Services takes the cost for the durable medical equipment back in 1987. Then, they figure the price for the current year using increases in fee schedule amounts. Unfortunately, for power wheelchairs, most of the technology we have today was not around in 1987. As a matter of fact, most of the power wheelchairs we have today were not even around before 2000. This makes the billing prices incomparable for that durable medical equipment from 1987 to today.

A medical billing study was conducted by a company called Muse & Associates for the American Association for Home care. The goal was to see how much more money, or less money the gap-filling method would bring. They concluded that the gap-filling method would bring about 25% less money to providers of power wheelchairs. This is because the billing of a medical power wheelchair back in 1987 would have been substantially less since the technology wasn’t as advanced. They advised the Centers for Medicare & Medicaid Services to use 1992 as the estimation year because that would make the medical billing prices somewhat comparable.

All durable medical equipment technology becomes better and better through the years. If the Centers for Medicare & Medicaid Services decides to use the gap-filling method in 1987 for power wheelchairs, the medical reimbursement when billing will be severely low.

View all Articles by: Melissa Clark, CCS-P