Aeroflow Mobility Blog

changes in medicare reimbursement

Changes in Medicare Reimbursement

So many of us have looked forward to the year 2016 for so many reasons, but this year some mobility patients are feeling frustrated and neglected. The products they depend on will either not be available to them any longer or the out of pocket expenses will increase for these Medicare recipients who are so often on a fixed income. So we have covered some of the changes in Medicare reimbursement that you might see this year.

These changes have occurred because Medicare issued a rule that requires lower prices for certain mobility accessory items that were not included by Congress in the competitive bidding program. The competitive bid program was put in place by the Medicare Modernization Act of 2003 to keep companies from monopolizing the market. These products were not included at the time the bill was passed in 2003, and therefore a lower bid could not affect these patients by increasing their out of pocket expenses. Then an additional bill was passed in 2008, the Medicare Improvements for Patients and Providers Act, which specifically exempted these items from being part of the competitive bidding program. This would be good, if not for the fact that these items are now required to be a part of the competitive bidding program.

If you are not familiar with the Medicare competitive bidding program, it was established to have medical providers submit bids to Medicare with lower prices than they currently pay for certain items. With this, Medicare enters into a contract with that company, saves money and establishes a trusted group of providers who have to comply with Medicare requirements in order to continue providing this equipment.  This is supposed to benefit patients, but some items and services were not included, as mentioned above. This affects those who are wheelchair dependent and those who use special accessories specific to their conditions. The following items are in question for changes in Medicare reimbursement:

-Wheelchair seat and back cushions that provide proper positioning and pressure release

-Power recline and tilt systems to change positioning for better breathing, blood flow and pressure ulcer prevention

-Specialty drive controls for individuals who must use alternative means to operate their complex wheelchairs

Pemobil President and CEO Larry Jackson states, “If Medicare moves forward with this rule, the severely disabled who depend on these products will see their health and independence jeopardized.  We strongly urge CMS and the Administration to rescind this rule to protect our country’s most vulnerable,” he adds.  Another disability advocate and Medicare recipient named Jenny Border contributed, “Life as an independent person with mobility issues will become significantly harder if this rule is not stopped, says Jenny Border, a disability advocate and Medicare recipient, in the release. “These items are not a luxury, and people need them to live their daily lives.”

Currently, there are several petitions circulating to let Congress know this is not the preferred way to go when it comes to changes in Medicare reimbursement, and how it affects those who really need these products. If you have questions or comments on how this may affect you, please get in touch with the mobility department at Aeroflow Healthcare at 888-345-1780. We can help you get the products you need through your health insurance. Just fill out our insurance qualification form and we will contact you soon!

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