Ken Nelson has been in the business of selling wheelchairs since 1963. “I was there when Medicare started,” he says. “And this new CMS clarification is one of the worst things that has ever happened.” On Dec. 9, 2003, CMS–the Centers for Medicare and Medicaid Services–issued a policy clarification that limits coverage on power mobility devices to people who are strictly nonambulatory: “Power wheelchairs … are covered only for patients who are nonambulatory. If a patient can only bear weight to transfer from a bed to a chair or wheelchair, the patient is considered nonambulatory,” reads the clarification.
Nelson, president of Wheelchair Works in Milwaukie, Ore., says Medicare beneficiaries who are unstable and at risk of falling are being denied power wheelchairs. “We’re sitting on 30 to 40 orders for power chairs because we don’t know what to do.” According to Nelson, Medicare will not reimburse his company if the power wheelchairs are delivered. “If they can walk at all,” he claims, “I have to say, ‘I’m sorry, I can’t sell you a chair.’ It gets my blood pressure boiling.”
Sources in the durable medical equipment industry say the strict clarification is the result of an overaggressive CMS crackdown on fraudulent sales and billing scams that caused an astronomical increase in Medicare payouts for power wheelchairs and scooters–mostly intended for use by elderly people–over the past two years. “We’re being looked at with a jaundiced eye,” says Nelson, a past board member of the National Registry of Rehabilitati