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By James Swann
Medicare could save millions of dollars by requiring beneficiaries to rent nonstandard power wheelchairs instead of buying them upfront, the program’s inspector general reports.
Medicare would have saved $10 million from 2011 to 2014 if beneficiaries had been required to rent their nonstandard power wheelchairs on a monthly basis, according to a report from the Health and Human Services Office of Inspector General released May 22. The OIG recommended that the Centers for Medicare & Medicaid Services ask Congress to bar the upfront purchase of nonstandard power wheelchairs for Medicare beneficiaries.
The Affordable Care Act eliminated lump-sum purchases of standard powered wheelchairs and imposed renting under Medicare in 2011, yielding roughly $86 million in savings from 2011 to 2014.
Medicare billing for power wheelchairs has been the subject of numerous criminal health-care fraud prosecutions alleging that some providers bilked Medicare out of millions of dollars for equipment that wasn’t needed or used, Ellyn Sternfield, a health-care attorney with Mintz, Levin, Cohn, Ferris, Glovsky and Popeo PC in Washington, told Bloomberg BNA May 22.
The report’s findings on the savings from eliminating upfront purchases for standard wheelchairs appear to justify expanding a similar policy to all Medicare-funded power mobility devices, Sternfield said.
While the payment policy change for standard power wheelchairs has produced savings, questions remain about how it has affected Medicare beneficiaries’ access to wheelchairs, Sternfield said, and the OIG report doesn’t address those impacts.
“Do those who need power wheelchairs still get them in a timely manner? Have beneficiaries experienced any continuity of care issues when the time period for rental is running short?” Sternfield said.
Power wheelchair ownership is transferred to a beneficiary after a 13-month rental, and, Sternfield said, questions remain as to whether beneficiaries are experiencing problems getting their wheelchairs serviced once they own them.
The CMS said it would consider the report’s recommendations and noted it is constantly reviewing payment policies. However, the agency said, it didn’t plan to ask Congress for legislation.
The American Association of Homecare didn’t provide a comment on the report’s recommendations.
Nonstandard power wheelchairs are designed for patients with complex medical conditions and can include power seating systems and special controls.
The Medicare savings from switching to a rental model would certainly be helpful, but, Sternfield said, shouldn’t be the sole reason for a policy change. “It’s incumbent on the OIG and the CMS to examine whether the incremental change in policy has had any adverse impact on beneficiaries before moving to implement the policy across the board to all power mobility devices,” Sternfield said.
The OIG said renting costs the Medicare program less than purchasing as many beneficiaries require a nonstandard power wheelchair for a limited amount of time. From 2011 to 2014, 16,626 out of 85,761 nonstandard power wheelchairs were purchased by beneficiaries whose needs or eligibility changed during the standard 13-month rental period.
Beneficiary eligibility can change due to death, admission to a long-term care facility, the end of Medicare Part B benefits, or a transfer to a Medicare Advantage plan.
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The OIG report is available at https://oig.hhs.gov/oas/reports/region5/51500020.pdf.
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