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American Association for Homecare: CMS Inexcusably Releases Flawed Utilization Data
Date:11/16/2011

The problem results from a new policy that eliminated a Medicare beneficiary's option to purchase their power wheelchair in the first month it was delivered.  Under the old system, a physician prescribed a power wheelchair, a provider delivered it and when the Medicare patient indicated that she/he wanted to own the chair, the government reimbursed the provider.  Now, however, under the new system providers are reimbursed in 13 monthly rental payments.   In compiling utilization data, the government now counts each monthly rental payment as if it were a new Medicare beneficiary obtaining a power wheelchair.  

In September, HME News reported that the data indicated that standard power wheelchair utilization has "skyrocketed." For example, HME News reported that in one of the four Medicare regions the number of beneficiaries increased from 5,411 (February) to 9,498 (March) to 12,525 (April).  Explaining the increases, HME News said the data indicates the "same beneficiary is counted each month, instead of, when there was a first-month purchase option, only once at the time of purchase."

Across the country, providers are frustrated and stunned by the erroneous data:  in reality, the new system has created severe financial and operation problems for providers.  Some are going out of business or no longer providing power wheelchairs to Medicare beneficiaries.  

Take Serina Breen. She worked for a home medical equipment company before starting her own business in 2009.  As an employee for the company, she provided more than 400 power wheelchairs to Medicare beneficiaries from 2006 to 2009. Once she started her business in Rodeo, CA, she said the audit risks, charge backs and excessive paperwork caused her to "purposely" limit sales to Medicare patients. The problems she experienced mirror the challenges faced by other providers.

Since 2009, she has provided
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SOURCE American Association for Homecare
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