What Can You Do to Help Make a Positive Change

If you know me, you know that I attempt to do the very best at whatever I choose to do in life.  In regards to my work, I am passionate about helping others through Seating and Mobility.  Over the past few years, there has been an attack by CMS/Medicare on this small industry that positively affects so many people; allowing them to live a more productive and independent life.  With the help of Active Mobility, I have been able to spend time advocating and lobbying for access to these services.

The number one (1) complaint that we here at Active Mobility Center, is that it takes too long to receive new equipment, and that the hoops needed jump through are unbearable.  As an industry we have done a poor job educating the public on how to advocate for themselves. We, as a collective group, always want to satisfy our customers, avoiding all the negativity of the increasing pressures.  When there was more of a margin/profit on medical equipment, we could hire more staff and facilitate equipment faster; however now with these changes- we have to do more with less.

These increased funding pressures, combined with the amount of requirements now to qualify and prior authorize equipment is making this process much more lengthy. CMS/Medicare had created new watch dogs who are bounty hunters only profiting by finding errors in paperwork, so suppliers have to spend much more time on the details; than the actual equipment provision.

Over the past few years, you may have heard of a program called competitive bidding. This program, no longer only a Medicare problem; has been finding it's way into the private sector; and if Obama's plans go into affect in 2015, will affect state medicaid programs. 

As of April 1st 2014, Manual Tilt in Space wheelchairs as well as some other DME products will become capped rentals. Many providers have already voiced their concerns that they will no longer be able to accept this and will no longer provide these services.

Equipment providers can no longer afford to be the sole Advocate for the users of medical equipment. The pressures exerted have taken the profit out of the system and where equipment users will need to get involved to avoid access to these services.  There are many ways that you can get involved, from contacting CMS/Medicare, your state and local representatives, or attend lobby groups to show how important this is to you and others.

Staying in touch through NRRTS.org, NCART.us or other similar organizations can help guide you and help your voice be heard.

This article was written by Carey Britton, ATP/SMS, CRTS for Active Mobility Center. He can be reached for comment at cbritton@wheelchairguys.com or at 954-946-5793.

It's Time to Advocate for the Future Access of Complex Rehab Equipment

Demand your Rights, Get out and Live !

For years, the DME (Durable Medical Equipment) and HME industries have given away too much in the attempt to best service our customers.  Our industry is comprised of caring individuals who want to make a difference in the lives of patient's we serve. What drives us is that we know at the end of each day, we made an impact, and improved the lives of the people we touched.

The DME and HME industries were created to help reduce the costs of Health Care. Research shows that getting a patient home from the hospital they heal and recover faster. Having a system where equipment and services are provided to the home reduces costly Hospital and Nursing Home Care. The DME industry is 1% of the Healthcare Budget, and saves a lot of money.

In the past few years, the pressures of insurance reductions, fraud and abuse, and increasing equipment costs have affective the way we conduct our service delivery.  What started out as a noble profession of helping, has become a business of becoming efficient.

Caring for our customers, we created networks and groups to lobby the state and federal governments trying to avoid further reduction in access to wheelchairs, scooters, powered wheelchairs, standers, gait trainers and seating and mobility equipment.

What happens at CMS/Medicare is adopted by all other insurance carriers; so those who don't care what happens with Medicare are fooling themselves. Many of our customers cannot speak, many fear that if they complain and lobby that they could lose more than they already have, and others don't know how. Many providers have continued to give away services and equipment and now are no longer able to.  We have failed to educate our customers, and now we are caught in an insurance system who isn't paying and customer's who are angry that they can't get what they used to.

Suppliers and Manufacturer's have commited time and resources to this battle; however since these groups profit from the provision of this equipment their voices are not heard as loudly as when it comes from the customers and beneficiaries of these insurances. Beneficaries will need to Advocate or Accept reduced access to quality equipment and services.

In the past few years, Medicare has instituted competitive bidding, where they forced providers to issue their lowest bid in order to stay in business. The first round of bidding caused hundreds of companies to go under, and 33% of the winning bidders closed within the first year.  This program is being launched nationwide this year, and will certainly cause havock on beneficaries.  As you may have seen the Scooter Store was raided and closed (for now), and all of their customers are stranded. Since they were investigated for fraud, providers are concerned. If a provider repairs and submits a claim for one of these customers, and that customer's paperwork is investigated and found that the Scooter Store did not complete their paperwork properly, that the funds for the chair and all services can be recooped by Medicare.

CMS/Medicare in the past two years had created a system where private companies are auditing providers in hopes to find missing or incomplete documentation so they can recoop money back to Medicare. These companies (bounty hunters) receive money based on this recoopment.  Generally these recoopments are not because the customer/beneficiary didn't need the equimpent, not because they didn't get the equipment; but because their was a T-not crossed or an I not dotted.

Major insurance companies are following Medicare's programs, and it is affecting everyone needing durable medical equipment (DME).  Many DME companies have stopped accepting Medicare as a payment sources as the risk of audits are too great.

There is still time to improve access to this life enhancing equipment.  There are several groups looking for your and your voice to send a message that will affect the future of Medical Equipiment. I encourage you to research these groups and commit to sending emails and making calls to help reduce the future pressure. We cannot afford to lose more companies with the baby boomer population retiring and who will need access to these services. With the pressures from Insurance, the risks are too great for any new companies to invest in the infrastructure of a company to provide these services.

Important Pending Legislation

HR-942- House Bill to Separate Complex Rehab Technlogy Equipmentt from DME, an important step in ensuring Access
S-948- Senate companion bill to separate Compex Rehab from DME

HR-1717- Bill to Stop Competitive Bidding


Get involved:
NRRTS- National Registry of Rehab Technlogy Suppliers
NCART- National Coalition for Assistive and Rehab Technlogy
USREHAB- a Division of VGM
Users First- Voice of Consumers using Equipment

Any questions or comments can be directed to Carey Britton with Active Mobility Center, located in Pompano Beach, Florida.

Why Care what Medicare Does?

Living in the United States, unless you are over 65 you probably do not care about what Medicare does. What may surprise you is that decisions that are made at CMS/Medicare affect what private insurer's and Medicaid does.  Private insurance uses what Medicare does on the Federal level as a guideline of what minimum services they need to offer.

CMS uses SADMERC, a group that determines coverage, and coding of all DME (Durable Medical Equipment). These codes are universally used by all insurance/funding groups.  Medicare establishes a fee schedule and longevity of each product code which is published.  Once a fee schedule is published it is accessible by all other insurance providers.

Generally private insurance PPO's use a formulary that offers higher fee's paid to service providers (Doctors, Clinicians, and Equipment Suppliers).  Private Insurance HMO's use a fee schedule closer to what Medicare offers. Medicare HMO's use a fee schedule lower than the Medicare fee schedule as they generally package other benefits into their program and uses the lower fee schedule to offset the additional benefits.

Presently in the DME industry, there are three (3) important battles shaping up......

Competitive Bidding

The First major issue is competitive bidding, which was introduced in 2010, and was trialed in 10 metropolitan areas. Although it hasn't been a total failure, it has caused a huge reduction in access. In the first year of 2010, almost 1/3 of the winning providers went out of business unable to perform under the agreed contract.  In 2012, the Scooter Store was closed down by the Government, and had contacts in all contact areas.  In 2012, the 2nd round of competitive bidding starts in July, if not stopped, will affect the entire United States.

What is Included in Competitive Bidding?
Most DME equipment including; wheelchairs, scooters, group 1 and group 2 powered wheelchairs, beds, mattresses, patient lifts, canes, walkers, oxygen and respiratory products and many other supplies.  Not one company won all the bids, so it is possible if you need multiple products, you may have different suppliers for each one.

Less providers equal less access. You know when you have a problem with FPL or ATT, that you are stuck. You cannot switch your business to another provider.  Once these companies are struggling and do not have adequate funding to survive, will they care about unsatisfied customers?  If they have limited reimbursements, less options, and less quality products and services will be offered. Since DME has a life expectancy of five (5) years, if the equipment is not as durable, will beneficiaries become stranded if the equipment is of less quality?

Further we have seen from what occurred with the Scooter Store, that beneficiaries of equipment have become stranded. It is not recommended to provide service to a customer whom you did not provide their equipment and do not have the supporting documentation in your files. As you will read shortly, in an audit from the initial company, if CMS/Medicare finds that the equipment was provided inappropriately, not only will the money for the equipment purchase be recouped, but also will any services provided for that equipment. When additional suppliers of DME disappear, their customers are severely disadvantaged and will most likely have to personally pay for services, or go back through the process gather medical documentation to support the need for their equipment.

Several economists have shown that this system will fail. A system where you force an industry to bid low or no longer be able to stay in business does not foster competition, it creates fear, and survival instinct. Many companies bid low, not because it was a sound business decision, but a way to keep their business alive. There are many in Congress that have been trying to stop Medicare/CMS from moving forward with the competitive bidding program; however Medicare/CMS continues to boast huge savings; overlooking the destruction of businesses, the loss of customer choice, and reduced access to equipment and service.

The Second major battle are the audits. If it were not bad enough that CMS/Medicare created competitive bidding, they also hired companies, bounty hunters, to audit DME companies to ensure that they were billing properly and to avoid fraud and abuse.  This is where it gets interesting....Most recognize fraud and/or abuse by the providing of equipment to people who do not need it or billing equipment that was not provided.  Medicare determined that if they reviewed a file, even if there was medical need, if a date was not proper, or a signature not clear, that the claim could be deemed improper and money can be recouped from the provider.  I say again, it is not because the patient did not need the equipment, they are looking for a technicality to reclaim money from the equipment supplier. They do not go after the Physician, or Clinician, but the supplier.  This has cause these bounty hunter companies to become aggressive- they get a percentage of money recouped, so it is to their benefit to find things wrong.  If they find claims wrong they can extrapolate back several years based on a percentage of claims found not be correct and demand money back.  It is up to the supplier then to hire an accountant and attorney to dispute this, in most cases the company declares bankruptcy. As you can imagine, more and more companies are leaving the Medicare program to avoid these unfair audits.


Many private insurance companies are now looking a these types of audits.  The underlying question is whether these audits are for supplier integrity, or whether it is to recoup funding back to the insurance provider.  

The Third battle is over Complex Rehab Technology (CRT).  Complex Rehab Technology is described as equipment that is specialized and customized for an individual with mobility challenges. This level of equipment requires a greater knowledge, higher skill set and certification.  Currently these are the specialized companies who are the experts in your community.

The only current certificate required is an ATP- Assistive Technology Provider, which was set to be a
minimum qualification and is for general assistive technology.  There are other certifications currently offered (not yet required), Seating and Mobility Specialist  (SMS) and Certified Rehab Technology Supplier (CRTS).  With all the pressure from competitive bidding, many companies who did not receive a contract (winning bid) are trying to keep their businesses and are trying to migrate to providing complex rehab equipment.

An ATP certification requires only passing a test, it doesn't say you are qualified or good at providing CRT. An ATP who passes the exam on Monday is now on an equal playing field as an ATP who has been providing this level of equipment for 10 years. Would you want a Surgeon who just passed their board exam to perform your surgery or the Surgeon who has experience?

There is legislation in Congress and in the Senate attempting to separate CRT from DME.  This legislation has been years in the making, and spearheaded by NRRTS, NCART and United Spinal. These group are very concerned that the industry, filled with knowledge and experience, may soon disappear if not protected.  You can sign a petition for HR-942 and support CRT.

Tying this back together, what occurs with Medicare will carry over to Private Insurance and Medicaid. If/when you need equipment, unless you know how to fit yourself, and  know what is important, pro's and con's of different equipment and are handy to fix your own equipment; you need this industry to survive.  Many insurance companies are watching closely to these Medicare programs, and many have already adopted parts of the program.

Many manufacturers of Assistive and Rehab Technology Equipment have already frozen research and development- No further Innovation or Advancement.

It is short sighted not to care just because you do not need this equipment now. We are all aging and living longer, and it is inevitable that we will need some piece of adaptive equipment to continue with the quality of life we desire.  Baby Boomers are coming of age and this huge population will depend on Assistive and Rehab Technology to continue to live independently in their homes.  Without a unified effort, we may lose this industry, and lose the local service provider who will assist you when you have a need.

If you are motivated, you can contact your legislator and let them know how you feel. You can find you local representation by clicking here.

Carey Britton, ATP, SMS, CRTS, works for Active Mobility Center, and has been committed to lobby congress, and participate in the Advocacy of people requiring CRT.  Carey can be reached at (954) 946-5793 or emailed at cbritton@wheelchairguys.com