No stop to prepay review for certain power wheelchairs

Monday, August 5, 2013

INDIANAPOLIS – National Government Services (NGS), the DME MAC for Jurisdiction B, has reported a claims error rate for power wheelchair bases with options and accessories of 64% between April 1, 2013, and June 30, 2013. NGS examined 754 claims that were developed for additional documentation and it paid in full only 234 claims. The most common reason for denials: The physical and functional findings that were documented in the medical records failed to clearly establish medical necessity for power mobility. Additionally, NGS reported providers failed to respond to requests for additional documentation to support medical necessity 57 times. The DME MAC will continue to conduct a widespread prepayment medical review for all Group 2 power wheelchairs that do not possess the capability of adding a power seating option (K0820-K0829).