Pics/remarks of Icon?

[DaleB]

That's terrific the Icon is coded and 'in the system'! Good luck on the appeal. 9 would be nice. That removes it from consideration as a 'Medicare chair' but would be more in line with the price.

(fwiw, I wish I had some junk in the trunk. No way I'm making it another 10 years without this layer of nothing but skin breaking down, at some point. )

Originally Posted by JeffAdams

@Stephen212 - you might be right about the level of injury vis a vis Christian, my point was that for people with limited trunk control (like Christian, you, tooley) there's something, likely in addition to, the level of injury that contributes to needing to use structural elements to reposition, and my theory is that your "badonkadonk" is what's to blame. DaleB seems to support my postulation on your posterioration.

Seriously, dude - you got junk for days in the back - little wonder you don't think suspension is something you need - if everyone had it "built in" like you, Icon would be out of business.

@jakeyboy and toto - it's currently coded as a K0005, which we're appealing. The coding folks recently coded the Marvel as a K0009, and when I was there, I pointed that out to them, but their previous opinions didn't seem to inform their present ones. We'll keep pushing to have it coded as a K0009.

[JeffAdams]

@DaleB - the way you characterize it is a bit overstated I think - it's a grey area which I don't understand very well, and is a bit of a moving target - I don't envy the dealers who have to navigate these waters.

The modularity of the Icon is a benefit here, and was part of our strategy in the concept stage of the Icon - we had a lot of friends who had glass ceilings on the amount of money they could spend, and we quickly saw the mistake we had made last time around with an "all in" price.

Without violating any laws or statutes, an end-user can buy the base model of the Icon, using whatever funding/allowable they have to pay for it.

They can then (after delivery) use whatever other means they may have available to them to upgrade parts to get the top of the line version of the chair (carbon seat, sideguards, etc). This helps the end-user get the equipment they need, and also helps get the DME out of a potentially awkward legal grey zone.

No other manufacturer has a design that allows this to happen - eg. if you buy the Invacare A4, you can never upgrade it to the level of a T7A - it's just not possible, same as if you buy an Aero Z - you just can't upgrade to a ZRA2.

As an example, with the Icon, you can buy the base model, use your funding, and over time (with private funds or once your annual insurance allowable resets) buy an upgraded carbon seat that saves 1.5 pounds from the laminate one.

We wanted to provide the opportunity for the end user to build their dream chair over time if financial constraints (driven by funding models or just personal financial realities) made it necessary.

The laminate seat has all of the functionality of the carbon, but in exchange for a lower cost, there is a higher weight. One of the foundation principles was to maintain full functionality from the base model through to the version with all the bells and whistles.

[TexasWheelz]

Well you can do that with some other chairs. You can get a ZR with a sling seat, sling back, crap wheels/tires, no side guards, push handles...etc. and then go back and buy a carbon back, carbon seat, carbon side guards, better wheels, better brakes...etc. So while I you can turn a ZRA into a ZR you can turn a bare bones ZR into a much lighter ZR with more bells and whistles that insurance wouldn't pay for.

[jschism]

Originally Posted by TexasWheelz

Well you can do that with some other chairs. You can get a ZR with a sling seat, sling back, crap wheels/tires, no side guards, push handles...etc. and then go back and buy a carbon back, carbon seat, carbon side guards, better wheels, better brakes...etc. So while I you can turn a ZRA into a ZR you can turn a bare bones ZR into a much lighter ZR with more bells and whistles that insurance wouldn't pay for.

I think the point was that even with a ZRA2 or a Q7, you cannot make a wider/narrower or longer/shorter seat. cannot make the wheelbase longer if you get a TiLite that is a little too short frame length. backrest angle adjustment is a joke on those, icon has a simple turnbuckle, that you easily adjust while even sitting in the chair, try that on others. Most adjustable chairs have a very limited range for COG and seat heights, Icon has a very wide range and easily adjustable. The handling/maneuverability of the Icon is just as good, if not better than my ZR2.

[t8burst]

Originally Posted by stephen212

OK, I'll back of the Twinkies. Seriously, I'll concede that my posteriorus is adorable and (mercifully) there is still some skin left to pinch, but I'm not getting much lift off from it.

[stephen212]

Does this chair make my butt look big?

[DaleB]

Perhaps so, but having been personally involved in Medicare/caid fraud and abuse investigations, I've seen it all. Up coding/down coding is one of the most common abuses of the US Medicare system. I've been involved in medical licenses being revoked, businesses being lost, felony convictions, and HUGE fines. All specifically related to the act of up/down coding on billings. It's real, not grey, to me. I guess it comes down to what you know, and where one's expertise and experience with these matters come from, as to whether or not it's confusing.


As a DME, one can 'get away with it'. This may be seem confusing.


Also, as a DME, one can bill for a stock K0005 chair, and then sell non-covered options over the counter at retail, for that chair.


However, both billing for a service or device not performed or delivered, and balance billing are both, factually, against the rules. CMS rules are federal law, being drafted and ratified by Congress.


I know it happens every day. Part of my job used to be spotting it in the terabytes of Medicare/caid claims data that flowed past my desk, everyday!



Eta: I absolutely concede there may be some reg or exclusion for DME re: balance billing that I am unaware of. The rule book is thick.

Originally Posted by JeffAdams

@DaleB - the way you characterize it is a bit overstated I think - it's a grey area which I don't understand very well, and is a bit of a moving target - I don't envy the dealers who have to navigate these waters.

The modularity of the Icon is a benefit here, and was part of our strategy in the concept stage of the Icon - we had a lot of friends who had glass ceilings on the amount of money they could spend, and we quickly saw the mistake we had made last time around with an "all in" price.

Without violating any laws or statutes, an end-user can buy the base model of the Icon, using whatever funding/allowable they have to pay for it.

They can then (after delivery) use whatever other means they may have available to them to upgrade parts to get the top of the line version of the chair (carbon seat, sideguards, etc). This helps the end-user get the equipment they need, and also helps get the DME out of a potentially awkward legal grey zone.

No other manufacturer has a design that allows this to happen - eg. if you buy the Invacare A4, you can never upgrade it to the level of a T7A - it's just not possible, same as if you buy an Aero Z - you just can't upgrade to a ZRA2.

As an example, with the Icon, you can buy the base model, use your funding, and over time (with private funds or once your annual insurance allowable resets) buy an upgraded carbon seat that saves 1.5 pounds from the laminate one.

We wanted to provide the opportunity for the end user to build their dream chair over time if financial constraints (driven by funding models or just personal financial realities) made it necessary.

The laminate seat has all of the functionality of the carbon, but in exchange for a lower cost, there is a higher weight. One of the foundation principles was to maintain full functionality from the base model through to the version with all the bells and whistles.

[DaleB]

Originally Posted by stephen212

Does this chair make my butt look big?

Oh yeeeeeahhh....giggity giggity....

[grommet]

Originally Posted by DaleB

Perhaps so, but having been personally involved in Medicare/caid fraud and abuse investigations, I've seen it all. Up coding/down coding is one of the most common abuses of the US Medicare system. I've been involved in medical licenses being revoked, businesses being lost, felony convictions, and HUGE fines. All specifically related to the act of up/down coding on billings. It's real, not grey, to me. I guess it comes down to what you know, and where one's expertise and experience with these matters come from, as to whether or not it's confusing.


As a DME, one can 'get away with it'. This may be seem confusing.


Also, as a DME, one can bill for a stock K0005 chair, and then sell non-covered options over the counter at retail, for that chair.


However, both billing for a service or device not performed or delivered, and balance billing are both, factually, against the rules. CMS rules are federal law, being drafted and ratified by Congress.


I know it happens every day. Part of my job used to be spotting it in the terabytes of Medicare/caid claims data that flowed past my desk, everyday!



Eta: I absolutely concede there may be some reg or exclusion for DME re: balance billing that I am unaware of. The rule book is thick.

I defer to you on the heart of what you're saying but to be clear, breaking a Federal law is not a felony. It's a felony if the statute is listed as felonious. I worked for the National Park Service and we had all sorts of laws governing us and our visitors, some were misdemeanors, others felonies. It might surprise you what things are in each category, it can seem whimsical. I'm going off topic I think but as an ex Federal employee who had to deal with this stuff everyday, I itched to say something :-)

[chasmengr]

Originally Posted by JeffAdams

<the Icon is> currently coded as a K0005, which we're appealing. The coding folks recently coded the Marvel as a K0009, and when I was there, I pointed that out to them, but their previous opinions didn't seem to inform their present ones. We'll keep pushing to have it coded as a K0009.

Jeff, why are you appealing? What's the advantage of K0009 coding over K0005. I think a K9 coding would put it out of reach for many people because Medicare pays nothing toward a K9. What am I missing?