Consumers will often say to me, “I saw a guy at the store who just popped his wheelchair in and out of his car by himself and he said it only weighed 19 pounds.” Or the question may be posed in a slightly different manner such as “Why can’t I have a lightweight or ultra-lightweight wheelchair?” The people asking are usually elderly men or women looking for chairs they can easily load and unload from their car. We providers have to stop and explain that the problem is they want to go out! And if they want to go out, they will have to privately pay for the lightweight wheelchair because Medicare pays only for what is medically necessary in the home.

Manufacturers have made advances in standard and lightweight wheelchairs—allowing adjustability with frame height as well as interchangeable parts. All of this helps suppliers with limited inventories to meet the needs of various consumers. And this allows one wheelchair to meet various Medicare billing codes. The only problem is that many suppliers are scared to supply a wheelchair that falls in this category for fear of billing mistakes with the wrong code or billing modifier—especially if they are offering upgraded wheelchairs for patients that may qualify only for lesser wheelchairs.

If a supplier can stock only one wheelchair that can meet the needs of all their customers, that is certainly easier than stocking four different models. The problem arises if a supplier delivers a K0003 lightweight wheelchair to a customer who qualifies only for a K0001 standard wheelchair. The supplier would have to bill with the appropriate modifier to be appropriately downcoded or risk Medicare billing problems.

Michael Seidel, ATS, CRTS

Many suppliers are just stocking four different wheelchairs rather than taking advantage of available technology in today’s wheelchairs. A worst-case scenario is the supplier that just tells the referral source or customer that Medicare doesn’t cover “it” and delivers less-than-optimal equipment that does not meet the patient’s needs. Either way, the supplier is put in a less than desirable situation because of confusing funding guidelines.

Funding guidelines (mainly Medicare) have made a sea of confusion for many suppliers. Medicare’s recent crackdown on power wheelchair fraud and abuse has sent many suppliers right out of the market because of fears of billing problems with medical documentation. Look at the medical coverage criteria for a manual wheelchair. The basic coverage criteria are not much different from those for a power wheelchair. Both manual and power wheelchair users must be bed- or chair-confined and must require the use of a wheelchair inside their home.

There has not been a crackdown yet on manual mobility, but many suppliers hesitate to offer a wheelchair that can have many different billing codes. In fact, Medicare coverage guidelines are out of touch. We still make our senior citizens haul 40- to 45-pound wheelchairs around if they want to actually leave their home. Why would anyone would want to leave home for anything more than the grocery store or doctor appointments? (read the latter with sarcasm).

But when Medicare looks at medical documentation for a K0005 ultra-lightweight wheelchair, we must incorporate activities outside the home to establish why an ultra-lightweight wheelchair is needed. So you can see why some suppliers cannot follow the inconsistencies around the Medicare policy manual and just give up and supply only standard wheelchairs.

Manufacturers are making what suppliers are buying and suppliers are buying what they can get paid for! Ultimately, consumers must be the driving force behind the technology that gets delivered to them. Consumers need to be educated on the funding guidelines and what limitations those guidelines put on suppliers.

We must work with manufacturers, suppliers, and consumers to educate Medicare on the inconsistencies within their own policy guidelines and the unreasonableness of others’ policies. Limiting access to appropriate medical equipment that would make it easier on people to get out of their home and live life is not what society wants.

Michael Seidel, ATS, CRTS, is president-elect of the National Registry of Rehabilitation Technology Suppliers (NRRTS) and a certified rehabilitation specialist at Mobile Med Care Inc, Lenexa, Kan. He can be reached via e-mail: mseidel@kc.rr.com.