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misappropriation of codes leads to trouble for providers’ businesses and manufacturer wariness about innovation and product development, Stanley said.
“Just between coding descriptor changes and changes to what \[CMS\] claims is included in the base price, the industry lost over 20 percent in reim- bursement over a 20-year period from Medicare,” she explained. “And that’s without any price reductions or price freezes. That’s just from coding and policy changes — the industry lost 20 percent.”
Providers who nd it harder and harder to stay pro table so they can keep their doors open often don’t see the slow erosion that coding changes can cause.
“With the supplier, it’s not just him buying the item from \[the manufacturer\] and then it magically appears on the consumer’s chair and the bill just auto- matically gets to Medicare,” Stanley said. “There are costs. And especially with all the items \[CMS\] moved to capped rental, now not only do you have to bill it, but you’ve got to bill it 13 times.
“Most suppliers don’t really know what happened. They just suddenly wonder, ‘Why am I not making money doing this anymore?’”
So what’s the solution for providers who are losing the coding war via a thousand cuts, and manufacturers who are wary of developing new CRT products that will very likely be forced into an inappropriate and ill-funded code?
One answer would be the CRT indus- try’s separate bene t category effort, which would create a new bene t (and new HCPCS codes and allowables) for the seating and wheeled mobility products used by people with severe and perma- nent mobility-related conditions (see sidebar).
If and when that new bene t category is established, not only could existing coding problems be addressed — but increased differentiation could lead to more accurate equipment de nitions that would reward innovation and reduce
the temptation to manufacture cheaper products that just barely meet coding requirements.
An example is the existing K0005 manual wheelchair code.
“Think about the myriad models of ultralightweight wheelchairs,” Stanley said, “from titanium and carbon ber to chairs that are literally built based on the speci c person.
MobilityMgmt.com
MOBILITY MANAGEMENT | MARCH 2018 21
Products vary in features and function, clinical application, and costs to manufacture and provide. These products are not interchangeable — Rita Stanley
TEN YEARS OF INNOVATIVE
IDEAS AND PURE
PASSION