Monthly Archives: December 2016

Medicare CRT Wheelchair Billing Announcements

December 28, 2016

Dear CRT Providers and Manufacturers,

We wanted to notify you of 3 significant Medicare billing announcements that will impact you in 2017:

1.) Continued Use of KU Modifier for Billing for Group 3 Power Wheelchair Accessories with Dates of Service from January 1, 2017 through June 30, 2017- CMS has announced that “Section 16005 of the 21st Century Cures Act extends the PAMPA provisions of unadjusted fee schedules for Group 3 wheelchair accessories and cushions used with Group 3 complex rehabilitative power wheelchairs through June 30, 2017. To implement the extension, the 2016 KU fee schedule amounts have been updated by the 2017 0.7 percent covered item update and will be added to the 2017 DMEPOS fee schedule file. Suppliers should continue to use the KU modifier when billing for wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs with dates of service January 1, 2017 through June 30, 2017.” This is very good news and should prevent an interruption in the processing of these claims as we move into 2017.

2.) Payment Cut Recoupment for CRT Manual Wheelchair Accessories with Dates of Service from July 1, 2016 through December 31, 2016- Per the 21st Century Cures Act, the July 1, 2016 fee schedule (with related payment cuts to non-competitive bid areas) was rescinded until the issuance of the January 1, 2017 fee schedule. The result of this is CRT providers will be able to recoup any July 1 payment cuts that were incurred for CRT manual wheelchair accessories (and other impacted DME claims such as Group 2 Power Wheelchairs) with dates of service from July 1, 2016 through December 31, 2016. CMS has announced that it “is currently working to implement this section and will be providing contractor instructions for re-processing the applicable claims. There is no action required for the suppliers at this time. Formal instructions will be issued in the near future.” Here again, good news that will allow providers to reprocess these claims to obtain additional payments once specific instructions are issued by CMS.

3.) Required Prior Authorization for 2 Group 3 CRT Power Wheelchair Base Codes (K0856 and K0861)- CMS has announced that they will be putting in place a Prior Authorization system for 2 CRT power wheelchair codes: K0856- power wheelchair, group 3 std., single power option, sling/solid seat/back, up to 300 pounds; and K0861- power wheelchair, group 3 std., multiple power option, sling/solid seat/back, up to 300 pounds. This is part of a national DME Prior Authorization initiative and these first codes will be implemented in 2 phases. The initial phase will be effective on March 19, 2017 in the 4 states of Illinois, New York, West Virginia, and Missouri. The second phase will be effective in the remaining states in July 2017. The CMS Fact Sheet can be found here and provides additional details, including the goal of an initial prior authorization response within 10 days. We will be working with CMS on the implementation of this new system.

Thanks to everyone who worked hard to get the year-end legislation passed in Congress to provide the payment relief in items 1.) and 2.). We will share additional information as it becomes available.

Regards,

Don
Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754
dclayback@ncart.us |www.ncart.us

Congress Passes Six-Month Delay in CRT Power Accessories Cuts

December 8, 2016

Good News for CRT Stakeholders.

Yesterday afternoon the Senate passed a 6-month delay of inappropriate Medicare payment cuts to CRT power wheelchair accessories as part of the 21st Century Cures Act. The House of Representatives passed the bill last week and it now goes to the President for signing into law.

The Cures Act also includes Competitive Bidding “rural relief” language that will retroactively rescind the broad DME July 1, 2016 Medicare cuts until January 1, 2017. This will allow CRT providers to recoup payment reductions to CRT manual accessories and other items provided from July 1 to December 31, 2016. The rescinded payment cuts will go back into effect on January 1, 2017.

As we have reported, the year-end challenge was to get our CRT legislation attached to a larger bill before Congress adjourned. Thankfully we were included in a year-end bill. Unfortunately, it is a short-term fix and does not expand the delay to CRT manual wheelchair accessories.

The reality is our Congressional supporters worked hard to get the best relief achievable within a difficult and limited year-end legislative environment. This 6-month period allows time for us to work with next year’s new Congress and Administration to pursue a permanent and more expansive fix through policy or legislation.

We will start 2017 with Congressional CRT support at its highest level ever. This provides a solid foundation to get a permanent stop to these inappropriate CRT accessories payment cuts and to establish a Separate CRT Benefit Category.

We sincerely thank all the Members of Congress for their support, particularly our CRT champions. Our champions include Senators Portman (R-OH), Casey (D-PA), Cochran (R-MS), and Schumer (D-NY) along with Representatives Zeldin (R-NY), Sensenbrenner (R-WI), Crowley (D-NY), Brady (R-TX), Tiberi (R-OH), Kelly (R-PA), Nunes (R-CA), Price (R-GA), Loebsack (D-IA), Larson (D-CT), DeGette (D-CO).

Please email your Members and thank them. Let them know we look forward to working with them next year to get the needed permanent changes implemented to protect access for people with disabilities.

Finally, thanks to all the people and organizations who worked hard this year reaching out to Congress to secure their support. CRT stakeholders are proving that while it takes time to get the attention of Congress, if you have a good plan, good advocates, and polite persistence progress can be made.

More details will follow as we move ahead.

Regards,

Don

Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754
dclayback@ncart.us |www.ncart.us

 

House Passes 21st Century Cures Act

December 1, 2016

Good news! Last night the House of Representatives passed the 21st Century Cures Act, which includes our 6-month CRT power wheelchair accessories delay, by a vote of 392-26. This shows overwhelming support in the House and sends a strong message to the Senate.

The Senate will now take up the bill, likely next week. It may encounter some resistance there, but signs are positive for passage. In the meantime, reaching out to your Senators and encouraging them to vote yes will be helpful. The NCART Board of Directors will be in D.C. next week carrying that message.

We are halfway there. Let’s keep the momentum going and we will keep you updated.

Regards,

Don
Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754
dclayback@ncart.us |www.ncart.us

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