NCART wants you to know that we have been working very hard on behalf of the rehab industry and the people you serve to get a quick and valid solution to the problems that resulted from the interim fee schedule for the new wheelchair seating codes.
I contacted CMS pricing staff Oct. 4th, the day that the interim fee schedule forthe new wheelchair seating codes was released. I followed up in person with thesame staff on October 6th. I also had a lengthy conversation with the SADMERC Medical Director on the 6th.
I spoke with the Director of the Center for Medicare Managementat CMS and 5 of his top staff. They shared that they are currently discussing several options for resolving the pricing issues associated with the new wheelchair seating codes.
They recognize the problems with denied access for Medicare beneficiaries as well as patients being served by payers that mirror Medicare’s fee schedule.
CMS has proposed the following options or any mix of them:
1) Immediately recalculate the fee schedules. Then recalculate again in January, again in April and possibly again in July as more products are code verified by the SADMERC. My understanding is that some recalculation will happen regardless of other solutions that may be determined.
2) Rescind the fee schedule and pay using individual consideration until new codes can be implemented to solve the payment issues.
3) Temporarily move specific, adjustable products from codes K0652, 3, 6 and 7 to K0108 until additional seat cushion codes can be developed.
4) Develop new K codes to be implemented in April 2005 to further delineate products.
In addition to my efforts with CMS and the SADMERC, Dave McCausland, also an NCART member, has been working closely with me drafting proposals, contacting the DMERC Medical Directors and the SADMERC as well. His effort to make sure we are communicating the same messages between these important agencies has been tremendous.
Between those of us working on this issue at NCART, someone has been in communication with either CMS or its contractors on an almost daily basis since October 4th. NCART has been asked by CMS staff to work with the manufacturers that have submitted products to the SADMERC for code verification. We are to ensure that the manufacturers submit the oldest available pricing for their products to CMS if they have not done so already. Due to the formula CMS uses to develop the fee schedule, this information is crucial in ensuring that the most appropriate feeschedule is developed when CMS re-calculates.
I am also very pleased to share that Dr. Edwards, SADMERC Medical Director has tentatively agreed to provide an update on this important matter at the NCART update at Medtrade.
I will keep you informed of any news I receive in regards to this matter.
Regards,
Rita Hostak
President
National Coalition for Assistive and Rehab Technology