Wheelchair Repairs Obstacles Reduced!

Published in Complex Rehab on December 08, 2022

By Dan Fedor, Director of Reimbursement and Education, U.S. Rehab

Wheelchair repairs have been a hot topic recently with advocacy groups raising awareness about the ability for a wheelchair user to obtain timely repairs on their wheelchair. There are many obstacles that contribute to obtaining a timely wheelchair repair, but one of those obstacles will be eliminated and another will be reduced on Jan 1, 2023.

Continued Need

The MAC announced that effective Jan. 1, 2023, a recent order (SWO) by the treating practitioner for repairs may serve as documentation to justify the continued medical need. This is a change from the current policy (prior to Jan. 1, 2023), where only timely documentation in the beneficiary’s medical record showing usage of the item would suffice for continued need. Timely documentation is within 12 months preceding the date of the repair. In most cases, the treating practitioner would not document this in the medical record (chart note) without seeing the patient, thus causing a significant delay to do the repair and a huge inconvenience for the patient.

Since an order is not part of the medical record, it was not acceptable to show continued need prior to Jan. 1, 2023. This is huge in that continued need should no longer be one of the obstacles to performing a timely repair. Since an order is valid for 12 months, a supplier will only need one order for the wheelchair repair annually. Be sure that the order isn't for a specific part but for general "wheelchair repair." If it is specific to a part (i.e. repair motors), then that would only be sufficient for the continued need for the motor repair. Keep in mind that for Medicare and those that follow Medicare, an order itself is not required for repairs.

Example: The patient's wheelchair requires replacement motors as identified on Dec. 28, 2022, and the supplier obtains an order for "wheelchair repair" from the treating practitioner on Dec. 31, 2022. That order is valid to show the continued need for the motor repair and all repairs for 12 months. So, if the patient needs replacement batteries on Feb. 14, 2023, the only documentation required is the technician work ticket. In other words, another order is not required for battery replacement. As you can see, this will reduce the time it takes to replace the batteries and all repairs that occur within 12 months from the date of the repair order from Dec. 31, 2022.

Reimbursement Amounts (Allowables)

On Dec. 1, CMS published Medicare fee schedule adjustments for DMEPOS for the calendar year 2023. Adjustments differ depending on whether the items serviced are competitive bidding program items or in former competitive bidding areas (CBAs). Overall, these adjustments should help offset some of the significant cost increases that suppliers have incurred (parts, labor, fuel, vehicles, etc.) since 2020.

CBP items in former CBAs: +6.4%
CBP items in non-CBAs: +9.1%
Non-CBP items: +8.7%

While a good wheelchair supplier has always dedicated the necessary resources to their repair department to enable them to service the products they sell in a timely manner, some have not, which has also contributed to delays in wheelchair repairs. Hopefully, these increases in 2023 will entice those suppliers to dedicate adequate resources to their repair department.

See attached reference from the Standard Documentation Policy Article and below the section regarding the continued need for revision.

Effective Jan. 1, 2023, continued need can be documented by an order for repairs, and suppliers no longer need to obtain documentation from the medical record.

An order is much easier to obtain compared to documentation from the medical record (progress note/chart note) as the supplier may write up the entire order (SWO) for the treating practitioner to sign and date.

Standard Documentation Policy Article (effective Jan. 1, 2023)

Any of the following may serve as documentation justifying continued medical need:

A recent order/prescription by the treating practitioner for refills of supplies;
A recent order/prescription by the treating practitioner for repairs;
A recent change in an order/prescription; A properly completed CMN or DIF obtained prior to DOS 01/01/2023, with an appropriate length of need specified;
Timely documentation* in the beneficiary’s medical record showing usage of the item.

*Timely documentation - a record in the preceding 12 months unless otherwise specified elsewhere in the policy.

If you have any questions, please contact Dan at dan.fedor@vgm.com.

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