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CMS May Use Prices From Internet Suppliers To Set Wheelchair Payments

This article was originally published in The Gray Sheet

Executive Summary

The Medicare fee schedule for power wheelchairs, expected any day, may incorporate online supplier pricing data, a prospect that has alarmed stakeholders

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OIG on power wheelchair pricing

Medicare fee schedule for power wheelchairs paid on average 45% more than median Internet prices in the first quarter of 2007, HHS' Office of Inspector General finds in a 1report released Oct. 30. CMS announced its intention last year to use an Internet process to help set a new power wheelchair fee schedule; the agency met fierce opposition from industry stakeholders who argued payments would go down inappropriately (2"The Gray Sheet" Sept. 25, 2006, p. 13). Still, the payments have faced sharp cuts and CMS notes that competitive bidding being phased in for 2008 will give the agency more opportunity to realign Medicare payments with market prices. OIG says it plans to conduct more evaluations comparing Medicare fee schedule amounts to actual prices paid by suppliers

OIG on power wheelchair pricing

Medicare fee schedule for power wheelchairs paid on average 45% more than median Internet prices in the first quarter of 2007, HHS' Office of Inspector General finds in a 1report released Oct. 30. CMS announced its intention last year to use an Internet process to help set a new power wheelchair fee schedule; the agency met fierce opposition from industry stakeholders who argued payments would go down inappropriately (2"The Gray Sheet" Sept. 25, 2006, p. 13). Still, the payments have faced sharp cuts and CMS notes that competitive bidding being phased in for 2008 will give the agency more opportunity to realign Medicare payments with market prices. OIG says it plans to conduct more evaluations comparing Medicare fee schedule amounts to actual prices paid by suppliers

Medicare In Brief

2007 IPPS payments finalized: Final hospital inpatient payment rates released by CMS Sept. 29 are slightly different than the tentative rates announced in the inpatient rule Aug. 1, due to the incorporation of revised provider data. Final DRG weights vary by no more than 0.8% from the Aug. 1 figures, CMS says (1"The Gray Sheet" Aug. 7, 2006, p. 3). The standardized amounts are approximately $4 lower than the Aug. 1 tentative amounts, while the final outlier threshold of $24,485 is $10 higher. An April 3 order from the 2nd U.S. Circuit Court of Appeals required CMS to collect new data to recalculate the adjustment factor used to determine individual hospital payments...

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