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Thread: New Manual chair through Medicare/Medicaid understanding available options for 2018

  1. #21
    Senior Member pfcs49's Avatar
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    Quote Originally Posted by Smashms View Post
    well had the eval we are going with a tilite aero z matrix elite back, roho cushion and actually the same person who saw mw for my first chair in 2009 also did this one. so we had quite a bit to catch up with.lol i also found out i have a bit of scoliosis go figure she said that is why my body and back hurts after sitting for awhile i guess that explains it. so we are going for the matrix back instead this time. to give me some lateral support as well. she also said the next chair if we need to i can get a deeper back if i want to but she thought the 3' one would be enough. with some side laterals as well. she said all in all expect at least a 3 month wait maybe more if medicare gives them a hard time. and she has seen it since i do walk a bit in the house for excerise.
    A deeper back would be helpful at forcing me to stay well postured. I've used a 3" inset for years now. My hips and back are getting very contorted and i'm constantly (like every 45 seconds) trying to reposition myself. I'd love a more supportive back, but when folded, the side bolsters majorly restrict the fold.
    The resultant package is VERY difficult to get past the steering wheel in the car! The back canes are ~45* to the seat framing.
    69yo male T12 complete since 1995
    NW NJ

  2. #22
    Senior Member ChesBay's Avatar
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    Quote Originally Posted by pfcs49 View Post
    A deeper back would be helpful at forcing me to stay well postured. I've used a 3" inset for years now. My hips and back are getting very contorted and i'm constantly (like every 45 seconds) trying to reposition myself. I'd love a more supportive back, but when folded, the side bolsters majorly restrict the fold.
    The resultant package is VERY difficult to get past the steering wheel in the car! The back canes are ~45* to the seat framing.
    Probably a dumb question but can you remove back while breaking down chair? I know it adds an extra step but I pop the Jay III back off my chair before stowing in the car. I could lift it with the back on but a few less pounds is easier on my old shoulders. ( I don't recommend Jay III )
    Last edited by ChesBay; 01-11-2018 at 02:21 AM. Reason: eta typo

  3. #23
    Senior Member NW-Will's Avatar
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    i emailed both my PT and DME specifically about the ABN question last week... yet to hear anything back, conveniently ignored it seems.
    have to chase them up now.

    this is what I get pointed to regarding the change.

    http://www.hmenews.com/article/cms-l...al-wheelchairs



    Quote Originally Posted by Oddity View Post
    What change is she talking about? What did she have to say about the ABN and why that is no longer an option?

  4. #24
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    I just saw this thread today, and it's pretty relevant to my experience, I think. I got a TiLite TRa SuperLight for my last chair in 2012, and the insurance didn't balk at it at all. It didn't really fit right (crappy measuring from the DME rep) but I toughed it out for five years. In late November of last year, I placed an order for a ZRa SuperLight (did the measurements myself this time!) blissfully unaware of the elimination of the K0009 coding. I've just been out of touch, I guess, because it appears to be more or less common knowledge.
    Anyways, I filled out the order form and emailed it to the DME, who then put the order together and sent it off to TiLite. The DME sent me the quote from TiLite, which had the ZRa SuperLight listed.
    Yesterday, the chair arrived so I went to pick it up. The fit was great, so I signed the papers and took it home.
    At home, it hit me that the tubing was waaay to big to be titanium, and the back rest rigidizer bar was the standard straight one instead of the curved one that the superlight edition was supposed to come with. It seems that, without letting me know, they ordered me a Aero Z. I'm assuming it's because they figured my insurance wouldn't cover the titanium frame, but the fact that they didn't even tell me about the change is just infuriating.

    Edit:
    OK, now I'm second guessing myself. The frame looks and feels like titanium, and it has ZRA printed on the left caster stem. The back is not curved, so maybe they just missed the SuperLight option? I'm so confused. Did TiLite change the diameter of their titanium tubing since 2012?
    Last edited by taziar; 01-12-2018 at 12:45 PM.

  5. #25
    Senior Member NW-Will's Avatar
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    Quick question, who'd you use as your DME ?

    Quote Originally Posted by taziar View Post
    I just saw this thread today, and it's pretty relevant to my experience, I think. I got a TiLite TRa SuperLight for my last chair in 2012, and the insurance didn't balk at it at all. It didn't really fit right (crappy measuring from the DME rep) but I toughed it out for five years. In late November of last year, I placed an order for a ZRa SuperLight (did the measurements myself this time!) blissfully unaware of the elimination of the K0009 coding. I've just been out of touch, I guess, because it appears to be more or less common knowledge.
    Anyways, I filled out the order form and emailed it to the DME, who then put the order together and sent it off to TiLite. The DME sent me the quote from TiLite, which had the ZRa SuperLight listed.
    Yesterday, the chair arrived so I went to pick it up. The fit was great, so I signed the papers and took it home.
    At home, it hit me that the tubing was waaay to big to be titanium, and the back rest rigidizer bar was the standard straight one instead of the curved one that the superlight edition was supposed to come with. It seems that, without letting me know, they ordered me a Aero Z. I'm assuming it's because they figured my insurance wouldn't cover the titanium frame, but the fact that they didn't even tell me about the change is just infuriating.

    Edit:
    OK, now I'm second guessing myself. The frame looks and feels like titanium, and it has ZRA printed on the left caster stem. The back is not curved, so maybe they just missed the SuperLight option? I'm so confused. Did TiLite change the diameter of their titanium tubing since 2012?

  6. #26
    My understanding is that although Medicare Advantage has to cover what original Medicare covers, there is nothing stopping them from covering more. Therefore, they can provide the titanium upgrade if it's medically necessary even if Medicare guidelines disallow it. You might want Medicare Advantage for this reason.

  7. #27
    Senior Member Oddity's Avatar
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    Quote Originally Posted by NW-Will View Post
    i emailed both my PT and DME specifically about the ABN question last week... yet to hear anything back, conveniently ignored it seems.
    have to chase them up now.

    this is what I get pointed to regarding the change.

    http://www.hmenews.com/article/cms-l...al-wheelchairs
    Here is how it can still be done, From the article: (note, "try to wrangle reimbursement...from Medicare" doesn't mean the customer does anything. The provider still files the claim but the check is sent to you. It's Not up to the patient to do the work. This phrase is disingenuously deceptive. If you've been approved for the base chair already (advance determination is a good idea) it's no more risk or trouble or work. Just more money up front.)

    now the only choice providers have is to bill non-assigned for manual wheelchairs with titanium and heavy duty upgrades, leaving beneficiaries to pay upfront for the total cost of the chair and to try to wrangle reimbursement for the chair, but not the upgrades, from Medicare

    Edit: But, AKAIK, what I posted earlier still applies: A Medicare participant DME who accepts assignment for wheelchairs can't just bill Unassigned because we (or they) want to do it that way. They are obligated to bill assigned and accept assignment for everyone or no one. Gotta find a DME willing to work with you that already doesn't accept Medicare assignment. I don't know if this changed also, but reading the Medicare Claims Processing manual leads me to believe it hasn't. (Also, Section 50 of said manual is all about the ABN. Worth looking it up on CMS site if this matters to you.)
    Last edited by Oddity; 01-13-2018 at 08:24 AM.
    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  8. #28
    Senior Member NW-Will's Avatar
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    Thank you for the input .

    Quote Originally Posted by Oddity View Post
    Here is how it can still be done, From the article: (note, "try to wrangle reimbursement...from Medicare" doesn't mean the customer does anything. The provider still files the claim but the check is sent to you. It's Not up to the patient to do the work. This phrase is disingenuously deceptive. If you've been approved for the base chair already (advance determination is a good idea) it's no more risk or trouble or work. Just more money up front.)




    Edit: But, AKAIK, what I posted earlier still applies: A Medicare participant DME who accepts assignment for wheelchairs can't just bill Unassigned because we (or they) want to do it that way. They are obligated to bill assigned and accept assignment for everyone or no one. Gotta find a DME willing to work with you that already doesn't accept Medicare assignment. I don't know if this changed also, but reading the Medicare Claims Processing manual leads me to believe it hasn't. (Also, Section 50 of said manual is all about the ABN. Worth looking it up on CMS site if this matters to you.)

  9. #29
    Senior Member NW-Will's Avatar
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    Response regarding ABN from my DME.. this is Medicare with Medicaid as secondary...

    Yes, we do utilize ABNs. Unfortunately, this doesn't change the scenario. We have to abide by Medicaid's rules as well (not just Medicare). Because you have Medicaid, we are unable to collect any payment from you (as Medicaid does cover a wheelchair, of some type,
    under your benefits). Legally, we are not able to collect any difference from you between what Medicaid deems "medically necessary" and what you actually received. If you only had Medicare, then the ABN has a potential of being a tool in this situation. With that said, with this new Medicare rule (from the article http://www.hmenews.com/article/cms-l...al-wheelchairs), they may have even eliminated that option for non-Medicaid recipients as well.
    Again, I know that I continue to be the bearer of bad news, unfortunately, but we are contractually obligated to follow their rules...as nonsense as they may seem.



    Thanks!

  10. #30
    Senior Member Oddity's Avatar
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    Quote Originally Posted by NW-Will View Post
    Response regarding ABN from my DME.. this is Medicare with Medicaid as secondary...

    Wowwwwwww. Sorry dude.
    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

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