NCART appealing CMS Seat Elevation Fee Schedule Decision!

NCART has submitted an HCPCS coding application to formally appeal CMS’ decision to increase the fee schedule by $13, which was recently released. Wayne Grau, Executive Director of NCART, stated, “While we appreciate CMS’ willingness to listen to our concerns and review the follow-up information we provided, they indicated it could not be considered since it was not part of the public meeting process last year. In addition, we will highlight the problems using internet pricing, which does not reflect the additional significant costs to comply with Medicare requirements compared to that retail model.”

Regulatory Updates!

Relief from Same and Similar denials is now in place when

a PWC needs to be replaced.



Effective June 2, 2024, CMS requires Prior Authorization for all Power Mobility Devices being replaced within the 5-year reasonable useful lifetime. Prior authorization should be submitted as an expedited request and will be processed within two business days.

Replacement Due to Loss, Theft, or Irreparable Damage

The following documentation should be included with your request:

•    Information and/or detailed report(s) that explain the reason(s) leading to the need for replacement such a police report when the power mobility device (PMD) is lost or stolen. For an irreparable damaged PMD there should be documentation related to a specific accident or natural disaster, such as a fire or flood, to support the need for replacement equipment.

•    A physician’s written order prior to delivery (WOPD) for the new, replacement items.

If the original prior authorization was affirmed, the DME MACs will not review for medical necessity. When selecting “expedited request” you must indicate why the request is being submitted (i.e., lost, stolen, or irreparably damaged PMD) for it to be accepted.

Once the request is affirmed, the claim should be submitted with the RA modifier. Note claims for a replacement PMD submitted with the RA modifier that do not have an affirmed PA will be denied.

Replacements Due to Change in Medical Need or Reasonable Useful Lifetime Met

The following documentation should be included with your request:

•   A new face-to-face evaluation

•   WOPD

•   Documentation from the medical record that supports the need for the item

ordered and documentation to support the change in condition, if applicable.

NCART IN ACTION

• NCART participated in the DRP-CRT Call with various academic and

therapist organizations.

• NCART hosted the Payer Relations Meeting to discuss different

state-payer initiatives.

• NCART participated in the AMRG advisory board meeting.

• NCART participated in the Secure Ride Coalition meeting with United Spinal.

iNRRTS New Program

iNRRTS Launches the CRT Supplier Certificate Program

NCART applauds iNRRTS for launching its CRT Supplier Certificate Program. This is the only program specifically designed to prepare individuals for a career as a professional CRT Supplier. The online program is organized into three levels, comprising 15 individual CEU courses using the companion textbook Seating and Wheeled Mobility: A Clinical Resource Guide by Michelle Lange and Jean Minkle. A certificate is awarded for the successful completion of each level.

Level 1 is available now, and levels 2 and 3 are coming soon. For more information, please click here.

Tour Time

Summertime is upon us as we recently celebrated Independence Day. This is a perfect time for NCART members to schedule a tour of your location with your federal Representatives and Senators. Many legislators do not understand the value that CRT equipment brings to their constituents. Until they see, feel, touch, and try the equipment, they finally understand who we are and the value we bring. If you are interested in hosting a member of Congress at your location, please contact Wayne Grau at Wgrau@NCART.us so that we can assist you in creating a lasting impression that will help us move forward.

NCART & US Rehab Legislative Day-

SAVE THE DATE

NCART and US Rehab will host a Washington, DC, legislative event on September 24, 2024. The event will be an in-person event focusing on educating members of Congress about the current economic issues challenging NCART members as they focus on providing equipment to consumers. We will ask for legislative support for the passage of HR 5371 (Consumer Choice Bill) to allow consumers the right to pay out of pocket for their choice of manual wheelchair. We will be releasing more information about this event in the upcoming weeks. Stay Tuned…

Advocacy Quotes

“To be an activist is to speak; to be an advocate is to listen. Society cannot move forward without both.” Eva Lewis

NCART is the only national organization dedicating every effort and resource entirely to representing suppliers and manufacturers of Complex Rehab Technology (CRT) products. NCART is strictly focused on working with policymakers, legislators, and others to establish and maintain appropriate coverage and funding to protect and improve CRT access.

If your company provides or manufactures CRT, help us fight the negative trends in coverage and payment that continue to mount by becoming an NCART member. Your support will enable us to continue to advocate aggressively as we work to ensure that individuals with disabilities have access to the specialized equipment and services you provide.

You can easily and securely submit your application online by clicking the button below. For additional information or questions, please contact Wayne Grau, Executive Director, at wgrau@ncart.us or 570-902-9878.

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