High denial rate for power wheelchairs

Friday, January 31, 2014

INDIANAPOLIS - National Government Services denied 79.8% of power wheelchair claims between Oct. 1 and Dec. 31 because paperwork failed to demonstrate beneficiaries’ needs, according to a recent bulletin. The Jurisdiction B DME MAC reviewed 613 claims in a prepayment review of all group 2 power wheelchairs without the option of adding power seating. NGS found most were denied because face-to-face documentation failed to prove: a manual wheelchair was insufficient; that the beneficiary’s mobility limitations required a power device; or why the power-operated vehicle would not meet the beneficiary’s needs in the home, according to the bulletin. Others were denied because they did not show the beneficiary was unable to propel a manual chair.